Posterior fossa decompression with or without duraplasty for patients with chiari type I malformation and basilar impres
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ORIGINAL ARTICLE
Posterior fossa decompression with or without duraplasty for patients with chiari type I malformation and basilar impression: a meta‑analysis Siyi Cai1 · Ye Tian1 · Jianguo Zhang1 · Jianxiong Shen1 · Jianhua Hu1 · Feng Chen1 Received: 14 June 2020 / Revised: 14 June 2020 / Accepted: 13 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background To compare clinical effect and safety between posterior fossa decompression with duraplasty (PFDD) and posterior fossa decompression without duraplasty (PFD) in treatment of Chiari type I malformation and basilar impression. Methods A comprehensive computer search was conducted from 2000 to 2019. The quality assessment was performed by the QUADAS-2 tool. The clinical value of comparison between PFDD and PFD was evaluated by using the pooled estimate of sensitivity and specificity. In addition, sensitivity analysis and bias analysis were applied to ensure the accuracy of the results. Results Finally, 468 patients were enrolled in 6 studies and ultimately met the eligibility criteria. The PFDD and PFD groups were 282 and 186, respectively. The meta-analysis showed no significant difference in the Chicago Chiari Outcome Scale (COSS score) (MD = 0.14, 95% CI [−0.23, 0.50], P = 0.47; P = heterogeneity = 0.86, I2 = 0%). Meanwhile, Significant difference existed in length of stay (MD = −1.08, 95% CI [−1.32, −0.84], P = 0.001; heterogeneity P 75% is considered to be high heterogeneous. If I2 > 50%, the potential sources of heterogeneity will be analyzed by sensitivity analysis. In addition, when the heterogeneity is observed, a random effect model is used. Conversely, the fixed effect model was adopted without considering the heterogeneity. The funnel plot is used to test the potential publication bias.
Results Search process Electronic search ended with a total number of 533 articles. After a thorough reading, 70 papers met the preliminary criteria. In the further screening, 64 articles were excluded because the design of the study, insufficient data and type of the articles. Finally, 6 papers were selected for analysis. Figure 1 is a flowchart of identification, inclusion and exclusion, reflecting the search process and the reasons for exclusion.
European Spine Journal
Fig. 1 Flow diagram of the study selection
Characteristics of included studies Table 1 summarized the type of study reported and the total number of patients associated with each group. The contents include author, publication year, nation, age, group, sample size and recruitment time. This analysis consisted of a total number of 468 patients. All 6 articles were published from 2010 to 2018.
Table 1 Characteristics of studies included in the metaanalysis
The sample size is between 16 and 355. The study included 186 in PFD group and 282 in PFDD group.
Results of quality assessment The quality of the studies was assessed though the risk of bias table in the Review Manager 5.2 Tutorial, and Fig. 2 and Fig. 3 had showed the evaluation in this study. As
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