Prevalence of complications after surgery in treatment for cervical compressive myelopathy: A meta-analysis for last decade.
OBJECTIVE
We aim to perform a meta-analysis on prevalence of all kinds of operation-related complications following surgery treating cervical compressive myelopathy (CCM) and to provide reference for surgeons making surgical plan.


METHODS
An extensive search of literature was performed in PubMed/MEDLINE, Embase, the Cochrane library, CNKI, and WANFANG databases on incidence of operation-related complications from January 2007 to November 2016. Data was calculated and data analysis was conducted with STATA 12.0 and Revman 5.3.


RESULTS
A total of 107 studies included 1705 of 8612 patients (20.1%, 95% CI 17.3%-22.8%) on overall complications. The incidence of C5 plasy, cerebrospinal fluid (CSF), infection, axial pain, dysphagia, hoarseness, fusion failure, graft subsidence, graft dislodgment, and epidural hematoma is 5.3% (95% CI 4.3%-6.2%), 1.9% (95% CI 1.3%-2.4%), 2.8% (95% CI 1.7%-4.0%), 15.6% (95% CI 11.7%-19.5%), 16.8% (95% CI 13.6%-19.9%), 4.0% (95% CI 2.3%-5.7%), 2.6% (95% CI 0.2%-4.9%), 3.7% (95% CI 2.0%-5.5%), 3.4% (95% CI 2.0%-4.8%), 1.1% (95% CI 0.7%-1.5%), respectively. Patients with ossification of posterior longitudinal ligament (OPLL) (6.3%) had a higher prevalence of C5 plasy than those with cervical spondylotic myelopathy (CSM) (4.1%), and a similar trend in CSF (12.2% vs 0.9%). Individuals after laminectomy and fusion (LF) had highest rate of C5 plasy (15.2%), while those who underwent anterior cervical discectomy and fusion (ACDF) had the lowest prevalence (2.0%). Compared with patients after other surgical options, individuals after anterior cervical corpectomy and fusion (ACCF) have the highest rate of CSF (4.2%), infection (14.2%), and epidural hematoma (3.1%). Patients after ACDF (4.8%) had a higher prevalence of hoarseness than those with ACCF (3.0%), and a similar trend for dysphagia between anterior corpectomy combined with discectomy (ACCDF) and ACCF (16.8% vs 9.9%).


CONCLUSIONS
Based on our meta-analysis, patients with OPLL have a higher incidence of C5 palsy and CSF. Patients after LF have a higher incidence of C5 palsy, ACCDF have a higher incidence of dysphagia, ACCF have a higher incidence of CSF and infection and ACDF have a higher incidence of hoarseness. These figures may be useful in the estimation of the probability of complications following cervical surgery.
Department of Spinal Surgery, The Third Hospital of Hebei Medical University Hebei Provincial Key Laboratory of Orthopedic Biomechanics, Shijiazhuang, China.
Tao
T
Wang
Xiao-Ming
XM
Tian
Si-Kai
SK
Liu
Hui
H
Wang
Ying-Ze
YZ
Zhang
Wen-Yuan
WY
Ding
D002574:Cervical Vertebrae / Q000601:surgery*; D015897:Comorbidity; D017586:Diskectomy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007796:Laminectomy / Q000009:adverse effects / Q000379:methods; D017887:Ossification of Posterior Longitudinal Ligament; D011183:Postoperative Complications / Q000453:epidemiology*; D013117:Spinal Cord Compression / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods