The Choice of the Best Surgery After Single Level Anterior Cervical Spine Discectomy: A Systematic Review
Ricardo Vieira Botelho*, 1, 2, 3, Yuri dos Santos Buscariolli2, Marcus Vinicius Flores de Barros Vasconcelos Fernandes Serra3, Marcia Nogueira Pires Bellini3, Wanderley Marques Bernardo4
1 Spine surgery Service-Hospital do Servidor Público do Estado de São Paulo-São Paulo, Brazil
2 Faculdade de Medicina-Universidade Cidade de São Paulo (UNICID)-São Paulo-Brazil
3 Conjunto Hospitalar do Mandaqui-São Paulo, Brazil
4 Brazilian Medical Association. Guidelines Project and University of São Paulo-São Paulo, Brazil
The anterior cervical discectomy (ACD) is often used to treat spinal cord and nerve root compressions and the frequent use of interbody fusion (ACDF) has popularized it as a common practice associated or not with cages or plates for maintaining the intervertebral disc height.
The aim of this study is to clarify the effectiveness of ACD compared with ACDF, with or without the use of anterior cervical spacer (Cage) or instrumentation with plate fixation (ACDFI).
randomized controlled trials or quasi-randomized trials were selected for analysis in one segmental level. The comparison criteria were the rates of success and failure with surgery (Odom’s’ criteria), fusion rates and kyphosis rates. Electronic search was made in the MEDLINE database (Pubmed), in the Central Registry of randomized trials of Cochrane database and EMBASE.
Seven studies were selected for analysis.
Implications for practice: There is moderate evidence that clinical results of ACD and ACDF are not significant different. There is moderate evidence that addition of intervertebral cage enhance clinical results.There is moderate evidence that anterior cervical plate does not change the clinical results of ACD.
There is moderate evidence that ACD produce more segmental kyphosis than ACDF and ACDFI, with use of cage or plate.There is moderate evidence that ACD produce lower rate of fusion than ACDF and than the cages. There is limited evidence of the lower capacity of PMMA to produce fusion. There is limited evidence that fused patients have better outcome than non fused patients.
Keywords: Diskectomy, cervical spine, surgery, meta analysis.
open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.
* Address correspondence to this author at the Spine surgery service-
Hospital do Servidor Público do Estado de São Paulo-São Paulo, Haberbeck
Brandão 68-92, 04027040, Brazil; Tel: 55 11 55727576;
Fax: 551132762964; E-mail: email@example.com