[Anterior versus posterior approach for multilevel cervical spondylotic myelopathy: a meta-analysis]

To assess the clinical effectiveness and safety of anterior versus posterior approach for multilevel cervical spondylotic myelopathy.

The following databases were searched: the Cochrane Library, PubMed, EM base, OVID, CBM, Wanfang Data, CNKI. Relevant journals were manually searched for randomized controlled trials or clinical controlled trials(CCTs) that investigated the clinical effectiveness and safety of anterior and posterior approach for multilevel cervical spondylotic myelopathy. Two reviewers independently screened the literature according to inclusion and exclusion criteria, extracted the data, and assessed the methodological quality of included studies. Meta-analysis was performed by using RevMan 5.2 software.

Eight CCTs, involving 1 151 patients, were included. Significant differences were found between anterior and posterior approach with respect to complications, OR=2.19, 95%CI (1.50, 3.19), P<0. 000 1; and neural recovery rate, WMD=11.04, 95% CI(0.60, 21.47), P=0.04 . In addition, there were no significant differences in preoperative JOA scores, WMD=0.13, 95% CI (-0.20, 0.46), P=0. 44; postoperative JOA scores, WMD=0.45, 95% CI (-0.10, 1.00), P=0.11; operation time, WMD=39.43, 95% CI(-5.92, 84.78), P=0.09; and amount of intraoperative bleeding, WMD=5.46, 95% CI(-96.65, 107.58), P=0. 92).

There are no significant differences between anterior and posterior approach for multilevel cervical spondylotic myelopathy in the recovery of neural function of the spinal cord, operation time and intraoperative bleeding. However, posterior appreach showed fewer complications than anterior appreach.