Anterior Cervical Spondylosis Surgical Interventions are Associated with Improved Lordosis and Neurological Outcomes at Latest Follow up: A Meta-analysis

Zengdong Meng, Jing Yu, Chong Luo, Xia Liu, Wei Jiang, Lehua Yu, Rongzhong Huang, Zengdong Meng, Jing Yu, Chong Luo, Xia Liu, Wei Jiang, Lehua Yu, Rongzhong Huang

Abstract

Aim of this study was to evaluate the effect of cervical spondylosis surgery on cervical lordosis and to identify factors affecting the change by latest follow-up. Literature search was carried out in electronic databases and study selection followed a priori eligibility criteria. Random effects meta-analyses were performed to estimate effect size/s of change in lordosis after surgery (at latest follow-up) and metaregression analyses were performed to identify factors affecting this change. Nineteen studies (1845 patients; age 55.18 [95% CI: 54.78, 55.57] years; 60.99 [60.63, 61.36] % males; follow-up 25.59 [25.20, 25.99] months) were included. Whereas, corpectomy (4.06 [2.65, 5.46] degree; p < 0.00001) and discectomy (4.59 [2.07, 7.11] degree; p < 0.00001) were associated with increase, laminectomy (-1.87 [-8.40, 4.66] degree; p = 0.57) and laminoplasty (0.25 [-1.07, 1.56] degree; p = 0.711) were not associated with significant change in lordosis at latest follow-up. Change in Japanese Orthopedic Association (JOA)/modified JOA (mJOA) score at latest follow-up was also significantly (p = 0.0005) higher in anterior than in posterior surgery group. Change in lordosis at latest follow-up had significant positive relationship with follow-up duration but had significant inverse associations with age, male gender, and preoperative JOA/mJOA score, independently. In posterior surgery subjects, after adjusting for age and gender, preoperative JOA/mJOA score was significantly inversely related to change in lordosis.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
A PRISMA flowchart of study screening and selection process.
Figure 2
Figure 2
A funnel plot (Y-axis: effect size (theta) and X-axis standard error of the effect size) corresponding to the meta-analysis of the change in lordosis at the latest follow-up showing no significant publication bias.
Figure 3
Figure 3
Forest graph showing the surgery type-wise effect sizes of the change in lordosis at the latest follow-up. BL, baseline lordosis (average); LF, Last follow-up lordosis (average); FMN, foraminotomy; PEEK, polyetheretherketone;
Figure 4
Figure 4
Forest graph showing surgery type-wise effect sizes of the change in JOA/mJOA score at the latest follow-up. BLJOA, baseline JOA/mJOA score (average); LF JOA, last follow-up JOA/mJOA score; FMN, foraminotomy.
Figure 5
Figure 5
Forest graph showing the overall effect size of patients reported outcomes of the surgery with anterior approaches. ACCF, anterior cervical corpectomy and fusion; ACDF, anterior cervical decompression and fusion; COMI, Core Outcome Measures Index; Odom, Odom grading system; PEEK, polyetheretherketone cage; TIT, titanium cage.

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