Surgical approaches and outcomes for cervical myelopathy with increased signal intensity on T2-weighted MRI: a meta-anal
- PDF / 1,053,344 Bytes
- 7 Pages / 595.276 x 790.866 pts Page_size
- 33 Downloads / 149 Views
(2019) 14:224
RESEARCH ARTICLE
Open Access
Surgical approaches and outcomes for cervical myelopathy with increased signal intensity on T2-weighted MRI: a meta-analysis Xu Yuan1†, Chen Feng2†, Wang Yipeng2, Zhang Jianguo2 and Hu Jianhua2*
Abstract Objective: Increased signal intensity (ISI) on T2-weighted magnetic resonance imaging (MRI) often indicates severe compression in patients with cervical myelopathy (CM). The optimal surgical approach for CM patients with ISI on T2-weighted MRI remains unclear. This meta-analysis aims to compare the clinical outcomes between anterior and posterior approaches for the treatment of these patients. Methods: MEDLINE, EMBASE, Web of Science, and Chinese National Knowledge Infrastructure (CNKI) were searched for relevant studies through January 2019. Statistical comparisons were made when appropriate. Results: A total of 9 studies (748 participants) out of 1066 citations were included in this study. All of the selected studies were high quality, as indicated by the Newcastle–Ottawa scale and the Cochrane Collaboration tool for assessing the risk of bias. Clinical outcomes were compared between anterior and posterior approaches in 4 studies (237 participants). The preoperative Japanese Orthopedic Association (JOA) score was similar between the two groups [P = 0.98, weighted mean difference (WMD) = 0.01 (− 0.58, 0.59)]. The postoperative JOA score [P < 0.05, WMD = 0.68 (0.06, 1.30)] and recovery rates [P < 0.01, WMD = 0.12 (0.06, 0.17)] were significantly higher in the anterior group than in the posterior group. Conclusion: The anterior approach was associated with better postoperative neural function than the posterior approach in CM patients with ISI on T2-weighted MRI.
Introduction Cervical myelopathy (CM) is a common cause of progressive spinal cord dysfunction. The most common etiology for CM is spinal stenosis caused by cervical spondylosis and ossification of the posterior longitudinal ligament (OPLL) [1]. Surgical treatment aims to expand the cervical canal and relieve the compression of the spinal cord. There are two main surgical approaches: the anterior approach and the posterior approach. Anterior approaches, which can achieve direct decompression by directly removing the ventral stenosing focus, typically * Correspondence: [email protected] † Yuan Xu and Feng Chen are co-first authors. 2 Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China Full list of author information is available at the end of the article
comprise anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy decompression and fusion (ACCF). Posterior approaches, which can achieve indirect decompression by shifting the spinal cord posteriorly, typically comprise laminoplasty or laminectomy. The choice of the surgical approach for CM has been a controversial issue. Several recent metaanalyses concluded that the anterior approach is associated with better postoperative neurologic
Data Loading...
