Article record

前路与后路手术治疗非骨化性后纵韧带（OPLL）退变性颈椎病的疗效与并发症比较：系统评价与Meta分析

Comparative Therapeutic Effectiveness and Complications of Anterior vs Posterior Surgical Approach in non-Ossification of the Posterior Longitudinal Ligament (OPLL) Degenerative Cervical Myelopathy: A Systematic Review and Meta-analysis.

综述 Meta耳科IF 2.1Q2

文献信息

PMID	42815851
原文	在 PubMed 查看原文 ↗
发表日期	2026
作者	Farzin Farahbakhsh 查看其他 17 位作者 Sepehr Khosravi；Vali Baigi；Seyed Danial Alizadeh；Morteza Gholami；Mahgol Sadat Hassan Zadeh Tabatabaei；Amirmahdi Khayyamfar；Moein Khormali；Mohammad-Rasoul Jalalifar；Shahriar Ghashghaei；Ahmad Pour-Rashidi；Zahra Ghodsi；James D Guest；Benjamin M Davies；Bizhan Aarabi；Michael G Fehlings；James S Harrop；Vafa Rahimi-Movaghar
作者单位	Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran; Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. 查看其他 11 条单位信息 Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.；Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran; Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran.；Metabolic Disorders Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.；Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.；Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran; Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.；Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA; The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL, USA.；Academic Neurosurgery Unit, Department of Clinical Neurosurgery, University of Cambridge, UK.；Department of Neurosurgery, University of Maryland, Baltimore, Maryland, USA; Program in Trauma, R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA.；Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Division of Genetics and Development, Krembil Research Institute, University Health Network, Toronto, ON, Canada.；Department of Neurological and Orthopedic Surgery Chief, Division of Spine and Peripheral Nerve Surgery Director, Enterprise Neuroscience Quality and Safety Neurosurgery Director of Delaware Valley SCI Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.；Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Universal Scientific Education and Research Network (USERN), Tehran, Iran; Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran; Visiting Professor, Spine Program, University of Toronto, Toronto, Canada. Electronic address: v_rahimi@sina.tums.ac.ir.
期刊	World neurosurgery
SCI 分区	Q2
IF	2.1
研究类型	综述 Meta · 临床
所属专科	耳科

中文摘要

目的： 比较前路与后路手术治疗退变性颈椎病的疗效。
方法： 我们按照PRISMA方案系统检索了MEDLINE、EMBASE、Scopus和Web of Science。采用Hartung-Knapp置信区间进行随机效应Meta分析。结局以均数差（MD）或比值比（OR）及95%置信区间（CI）合并。功能结局根据最小临床重要差异（MCID）进行评估，并使用GRADE评估证据确定性。
结果： 共分析52项研究，包括22,562例前路手术和19,762例后路手术。与后路手术相比，前路手术与较低的C5神经根麻痹（≥3个节段：OR=0.35，95% CI：0.18-0.70）、颈痛（OR=0.31，95% CI：0.20-0.49）、感染（OR=0.28，95% CI：0.16-0.50）和血栓性并发症（OR=0.51，95% CI：0.31-0.86）风险相关，但吞咽困难风险较高（OR=3.80，95% CI：2.45-5.90）。前路手术总体上提供了更大的C2-C7 Cobb角前凸矫正（MD=5.92°，95% CI：3.32-8.52），在≥3个节段中也是如此（MD=6.51°，95% CI：2.08-10.93），且失血量更少（MD=-91 mL，95% CI：-167至-15）。功能结局的差异低于公认的MCID：颈部功能障碍指数差异为-2.85分（95% CI：-5.54至-0.15；MCID=7.5），而mJOA差异在<6个月时为-0.13（95% CI：-0.59至0.33），6-12个月时为0.36（95% CI：-0.16至0.88），超过12个月时为0.23（95% CI：-0.03至0.48）（MCID=2）。
结论： 前路和后路手术具有不同的风险和影像学特征，但功能结局无临床重要差异。低确定性证据限制了对优越性的结论。

英文摘要

OBJECTIVE: To compare the anterior and posterior surgical approaches for management of degenerative cervical myelopathy.
METHODS: We systematically searched MEDLINE, EMBASE, Scopus, and Web of Science following a PRISMA protocol. Random-effects meta-analyses were performed using Hartung-Knapp confidence intervals. Outcomes were pooled as mean differences (MD) or odds ratios (OR) with 95% confidence intervals (CI). Functional outcomes were assessed against minimal clinically important differences (MCID), and certainty of evidence using GRADE.
RESULTS: Fifty-two studies including 22,562 anterior and 19,762 posterior procedures were analysed. Compared with posterior surgery, anterior surgery was associated with lower odds of C5 palsy (OR=0.35, 95% CI: 0.18-0.70 for ≥3 levels), neck pain (OR=0.31, 95% CI: 0.20-0.49), infection (OR=0.28, 95% CI: 0.16-0.50), and thrombotic complications (OR=0.51, 95% CI: 0.31-0.86), but higher odds of dysphagia (OR=3.80, 95% CI: 2.45-5.90). Anterior surgery provided greater C2-C7 Cobb angle lordotic correction overall (MD=5.92°, 95% CI: 3.32-8.52) and for ≥3 levels (MD=6.51°, 95% CI: 2.08-10.93), with lower blood loss (MD=-91 mL, 95% CI: -167 to -15). Differences in functional outcomes were below accepted MCIDs: Neck Disability Index differed by -2.85 points (95% CI: -5.54 to -0.15; MCID=7.5), while mJOA differences were -0.13 (95% CI: -0.59 to 0.33) at <6 months, 0.36 (95% CI: -0.16 to 0.88) at 6-12 months, and 0.23 (95% CI: -0.03 to 0.48) beyond 12 months (MCID=2).
CONCLUSION: Anterior and posterior approaches have distinct risk and radiographic profiles, without clinically important differences in functional outcomes. Low-certainty evidence limits conclusions regarding superiority.