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Effect of various kinds of cervical spinal surgery on clinical outcomes: a systematic review and meta-analysis
Arianne P Verhagen1, Marienke van Middelkoop, Sidney M Rubinstein
1Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands Department of Epidemiology and Biostatistics, EMGO-Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands Department of Health Sciences, Faculty of Earth and Life Science and EMGO-Institute for Health and Care Research, VU University, Amsterdam, The Netherlands Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands Medical Center Haaglanden, The Hague, The Netherlands.
Abstract:
The choice of a specific surgical technique should be based on its benefits and harms. Previous reviews have shown that the benefit of surgery over conservative care is not clearly demonstrated in patients with disorders of the cervical spine. Also, no additional benefit of fusion upon anterior decompression techniques could be found. A clear overview of other surgical techniques is lacking. We therefore aimed to assess the benefits and harms of cervical spinal surgery in patients with cervical disorders. We searched MEDLINE, EMBASE, CINAHL, and CENTRAL up to June 2012. Randomized controlled trials (RCTs) were selected which included adults with cervical disorders receiving a surgical intervention and that reported at least 1 clinically relevant outcome measure (eg, pain, function, recovery). Two authors independently assessed the risk of bias using the criteria recommended by the Cochrane Back Review Group and extracted the data. The quality of the evidence was rated using the GRADE method. We included 39 RCTs comparing different surgical interventions. We found low-quality evidence for no difference in effectiveness between various surgical techniques used for anterior discectomy. There is a small, clinically irrelevant benefit on recovery and pain in favour of prosthetic disc surgery when compared with fusion techniques. Unfortunately, in these studies the authors had a clear conflict of interest. The differences in benefits and harms between the various surgical techniques are small. The surgeon, patient, and health care provider can therefore make the choice of any surgical technique based on experience, preferences, or costs.