Anterior cervical discectomy and fusion versus posterior laminoplasty for multilevel cervical myelopathy: A meta-analysis.

OBJECT:Anterior cervical discectomy with fusion (ACDF) and laminoplasty (LAMP) are used for the treatment of multilevel cervical myelopathy. Despite their widespread applications certain differences are noted between the ACDF and LAMP procedures. A meta-analysis was conducted in order to compare the clinical outcomes, complications, and surgical trauma between ACDF and LAMP for the treatment of multilevel cervical myelopathy. METHODS:Medline, EMBASE, Google Scholar, and Cochrane databases were used for the search of relevant studies until September 2016. The studies aimed to compare the ACDF and LAMP procedures for the treatment of multilevel cervical myelopathy. Title and abstract screening was carried out concomitantly, whereas full text screening was carried out independently. A random effect model was used for heterogeneous data. The data that did not follow heterogeneous pattern were pooled by a fixed effect model in order to examine the mean difference (MD) for continuous outcomes and the odds ratio (OR) for dichotomous outcomes, respectively. RESULTS:A total of 6 articles out of 1351 citations (379 participants) were eligible. Significant differences were noted between the two groups in the cobb angle of C2-C7 (MD = 4.00, 95%, CI = 0.83 to 7.17; p = 0.01) and with regard to the incidence of associated complications (OR = 3.61, 95%, CI = 1.72 to 7.59; p = 0.0007). However, no apparent differences were noted in the variables blood loss (MD = -24.16, 95% CI = -174.47 to 126.15; p = 0.75), operation time ((MD = 32.81, 95% CI = -26.76 to 92.38; p = 0.28), recovery rate of JOA score (MD = 4.00, 95%, CI = 0.83 to 7.17; p = 0.01) and incidence of associated complications (OR = 3.61, 95%, CI = 1.72 to 7.59). CONCLUSIONS:The present meta-analysis demonstrates that the rate of complications is lower in the laminoplasty. However, the cobb angle of C2-C7 was decreased in the ACDF group at the final follow-up period compared with the baseline. The outcomes of the variables blood loss, operation time, range of motion and recovery rate of JOA score, were similar in the two groups.