Hybrid Decompression Technique Versus Anterior Cervical Corpectomy and Fusion for Treating Multilevel Cervical Spondylotic Myelopathy: Which One Is Better?
BACKGROUND
The hybrid decompression technique (corpectomy combined with discectomy) and anterior cervical corpectomy with fusion (ACCF) both provide good neurological recovery and disease stabilization for the treatment of multilevel cervical spondylotic myelopathy (CSM). However, no single study has been large enough to determine definitively which one is superior for this condition.


OBJECTIVE
A meta-analysis was conducted to compare the clinical efficacy and safety of the hybrid decompression technique versus ACCF for the treatment of multilevel CSM.


METHODS
Electronic databases such as PubMed, MEDLINE, EMBASE, Google Scholar, and the Cochrane Library were selected to search for potentially relevant trials up to April 2015 that compared the outcomes of the hybrid technique with ACCF for the treatment of multilevel CSM. Data extraction and quality assessment were performed according to Cochrane Collaboration guidelines. The outcome assessments were duration of surgery, blood loss, Cobb angle of C2-C7, segment angle, fusion rate, Japanese Orthopedics Association score, Neck Disability Index, and complications. The results were expressed as the odds ratio (OR) for dichotomous outcomes and the mean difference (MD) for continuous outcomes with a 95% confidence interval (CI).


RESULTS
Five controlled clinical trials published between 2009 and 2013, involving 356 patients (hybrid, 196; ACCF, 160) with 3- or 4-level CSM were retrieved in this study. Overall, there were significant differences between the 2 treatment groups for blood loss (MD = -38.69, 95% CI = -54.62 to -22.76, P < 0.01), fusion rate (OR = 2.56, 95% CI = 1.11 to 5.93, P = 0.03), and complications (OR = 0.25, 95% CI = 0.15 to 0.43, P < 0.01). However, no significant differences were found for duration of surgery (MD = -4.50, 95% CI = -22.902 to 13.91, P = 0.63), Cobb angle of C2-C7 after surgery (MD = 3.32, 95% CI = -3.72 to 10.37, P = 0.35), segment angle after surgery (MD = 2.87, 95% CI = -2.47 to 8.21, P = 0.29), Japanese Orthopedics Association score (MD = -0.07, 95% CI = -0.36 to 0.22, P = 0.62), or Neck Disability Index (MD = -0.86, 95% CI = -3.26 to 1.54, P = 0.48).


CONCLUSIONS
Based on this meta-analysis, both the hybrid technique and ACCF can achieve good results for CSM. However, the hybrid technique is associated with significantly less blood loss, complications, and a higher fusion rate than ACCF.
Department of Orthopedics Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, P.R. China.
Jia-Ming
JM
Liu
Department of Pharmacy, the First Affiliated Hospital of Nanchang University, Nanchang, P.R. China.
Hong-Wei
HW
Peng
Department of Orthopedics Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, P.R. China. Electronic address: liuzhiliyfy@163.com.
Zhi-Li
ZL
Liu
Department of Orthopedics Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, P.R. China.
Xin-Hua
XH
Long
Department of Pathology, the First Affiliated Hospital of Nanchang University, Nanchang, P.R. China.
Yan-Qing
YQ
Yu
Department of Orthopedics Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, P.R. China.
Shan-Hu
SH
Huang
D002574:Cervical Vertebrae / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D017586:Diskectomy; D006801:Humans; D013118:Spinal Cord Diseases / Q000601:surgery; D013123:Spinal Fusion / Q000379:methods*; D055009:Spondylosis / Q000601:surgery*
Corpectomy; Hybrid decompression; Meta-analysis; Multilevel cervical spondylotic myelopathy