Document Detail


Single or double-level anterior interbody fusion techniques for cervical degenerative disc disease.
MedLine Citation:
PMID:  21249667     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The number of surgical techniques for decompression and solid interbody fusion as treatment for cervical spondylosis has increased rapidly, but the rationale for the choice between different techniques remains unclear.
OBJECTIVES: To determine which technique of anterior interbody fusion gives the best clinical and radiological outcomes in patients with single- or double-level degenerative disc disease of the cervical spine.
SEARCH STRATEGY: We searched CENTRAL (The Cochrane Library 2009, issue 1), MEDLINE (1966 to May 2009), EMBASE (1980 to May 2009), BIOSIS (2004 to May 2009), and references of selected articles.
SELECTION CRITERIA: Randomised comparative studies that compared anterior cervical decompression and interbody fusion techniques for participants with chronic degenerative disc disease.
DATA COLLECTION AND ANALYSIS: Two review authors independently assessed risk of bias using the Cochrane Back Review Group criteria. Data on demographics, intervention details and outcome measures were extracted onto a pre-tested data extraction form.
MAIN RESULTS: Thirty-three small studies ( 2267 patients) compared different fusion techniques. The major treatments were discectomy alone, addition of an interbody fusion procedure (autograft, allograft, cement, or cage), and addition of anterior plates. Eight studies had a low risk of bias. Few studies reported on pain, therefore, at best, there was very low quality evidence of little or no difference in pain relief between the different techniques. We found moderate quality evidence for these secondary outcomes: no statistically significant difference in Odom's criteria between iliac crest autograft and a metal cage (6 studies, RR 1.11 (95% CI 0.99 to1.24)); bone graft produced more effective fusion than discectomy alone (5 studies, RR 0.22 (95% CI 0.17 to 0.48)); no statistically significant difference in complication rates between discectomy alone and iliac crest autograft (7 studies, RR 1.56 (95% CI 0.71 to 3.43)); and low quality evidence that iliac crest autograft results in better fusion than a cage (5 studies, RR 1.87 (95% CI 1.10 to 3.17)); but more complications (7 studies, RR 0.33 (95% CI 0.12 to 0.92)).
AUTHORS' CONCLUSIONS: When the working mechanism for pain relief and functional improvement is fusion of the motion segment, there is low quality evidence that iliac crest autograft appears to be the better technique. When ignoring fusion rates and looking at complication rates, a cage has a weak evidence base over iliac crest autograft, but not over discectomy alone. Future research should compare additional instrumentation such as screws, plates, and cages against discectomy with or without autograft.
Authors:
Wilco Jacobs; Paul C Willems; Jacques van Limbeek; Ronald Bartels; Paul Pavlov; Patricia G Anderson; Cumhur Oner
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Review     Date:  2011-01-19
Journal Detail:
Title:  The Cochrane database of systematic reviews     Volume:  -     ISSN:  1469-493X     ISO Abbreviation:  Cochrane Database Syst Rev     Publication Date:  2011  
Date Detail:
Created Date:  2011-01-20     Completed Date:  2011-02-28     Revised Date:  2013-06-28    
Medline Journal Info:
Nlm Unique ID:  100909747     Medline TA:  Cochrane Database Syst Rev     Country:  England    
Other Details:
Languages:  eng     Pagination:  CD004958     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, Leiden University Medical Center, PO Box 9600, Leiden, Netherlands, 2300 RC.
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MeSH Terms
Descriptor/Qualifier:
Cervical Vertebrae / surgery*
Diskectomy
Humans
Ilium / transplantation
Intervertebral Disc* / surgery
Intervertebral Disc Displacement / surgery
Randomized Controlled Trials as Topic
Spinal Fusion / methods*
Spondylosis / surgery*
Comments/Corrections
Update Of:
Cochrane Database Syst Rev. 2004;(4):CD004958   [PMID:  15495130 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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