Microscope-assisted versus traditional anterior cervical approach for cervical spondylopathy: a meta-analysis.

BACKGROUND: In China, although microscope-assisted anterior cervical decompression has been performed by many spine surgeons in recent years, the application of microscope still needs to be further promoted in China. Therefore, it is necessary to systematically evaluate and analyze the clinical efficacy of cervical spondylopathy by comparing patients under microscope-assisted anterior cervical approach to traditional anterior cervical approach. As a result, it can provide the evidence for clinical decision in these cervical spondylopathy patients. OBJECTIVE: To systematically evaluate the effect between microscope-assisted anterior cervical approach and traditional anterior cervical approach in cervical spondylopathy patients. METHODS: Databases such as Medline, Embase, PubMed, Web of science, CBM, Wangfang databases, VIP, and CNKI were searched from inception to July 2019 to find literature related to microscope-assisted anterior cervical approach and traditional anterior cervical approach in treatment of cervical spondylopathy. Two investigators evaluated the researches independently and compared the operative time, intraoperative blood loss, the preoperative and postoperative Japanese Orthopedic Association score, neurological success rate, the preoperative and the postoperative visual analogue scale score, and the complication rates between two groups. The quality of the included literature was evaluated by the modified Jadad scale, the modified Newcastle ottawa score and the methodological index for non-randomized-studies. The correlative clinical outcome in inclusive research was analyzed systematically by using Stata 12.0 Software. RESULTS AND CONCLUSION: (1) Twelve studies were accorded with the inclusion criteria, containing 892 cases (438 cases in the microscope-assisted group, while 454 cases in the traditional group). (2) There were no significant differences in the preoperative Japanese Orthopedic Association score (WMD=-0.1 00, 95%CI(-0.459, 0.259), P=0.585), operative time (WMD=6.852, 95%Cl(-0.446, 14.149), P=0.066), the preoperative and postoperative visual analogue scale score (WMD=0.293, 95%Cl(-0.023, 0.608), P=0.069; WMD=-0.718, 95%Cl(-1.495, 0.059), P=0.070) between two groups. (3) Postoperative Japanese Orthopedic Association score (WMD=1.310, 95%Cl(0.621, 1.998), P < 0.001}, the rate of neurological success (WMD=4.639, 95%Cl(0.294, 8.984}, P=0.036} in the microscope-assisted group were higher than those in the traditional group. The intraoperative blood loss (WMD=-18.068, 95%Cl(-24.504, -11.632}, P < 0.001} and the rate of complication (RR=1.068, 95%Cl(1.012, 1.126), P=0.002) in the microscope-assisted group were significantly lower than those in the traditional group. (4} Performing anterior cervical approach under microscope has a better clinical effect than using traditional anterior cervical approach in the treatment of cervical spondylopathy, but more high-quality clinical studies are needed to verify it. [ABSTRACT FROM AUTHOR]