Subsidence Following Anterior-Only Anterior Cervical Corpectomy Fusion For Cervical Spondylotic Myelopathy: Systematic Review and Meta-Analysis.

IF 1.7 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Spine Surgery Pub Date : 2025-08-25 DOI:10.1097/BSD.0000000000001919

Rakesh Kumar, Aiyush Bansal, Annie Luo, Kenneth Nwosu, Anirudh K Gowd, Murad Alostaz, Jean-Christophe A Leveque, Venu M Nemani, Philip K Louie

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Abstract

Study design: Systematic review and meta-analysis.

Objective: To examine the occurrence and potential contributing factors of interbody subsidence following anterior-only ACCF performed for CSM.

Summary of background data: Surgical interventions for cervical spondylotic myelopathy (CSM) frequently involve anterior approaches, such as anterior cervical discectomy/fusion (ACDF) or anterior cervical corpectomy/fusion (ACCF). Although graft subsidence is a well-established and described complication in ACDF procedures, much less has been published regarding factors related to subsidence in patients undergoing anterior-only ACCF for CSM.

Methods: A systematic literature search was conducted using PubMed, Embase, and COCHRANE. The study's inclusion criteria encompassed anterior-only anterior cervical corpectomy and fusion (ACCF), surgery for the primary diagnosis of cervical spondylotic myelopathy (CSM). Qualitative analysis was performed for complications and revision rates. The data were subjected to meta-analysis to evaluate subsidence incidence rates, and meta-regression analysis was used to assess variations between different graft types.

Results: Two hundred forty-five abstracts were evaluated and 34 papers met the inclusion criteria. Two thousand five patients were evaluated over a mean of 31 months (range: 6-56 mo). Pooled subsidence rates expressed as incidence per person-years based on graft type were as follows: 2% (carbon fiber), 27% (fibular strut allograft), 2% (nHAPA composite strut), 5% (PEEK), 10% (static titanium), and 2% (expandable titanium cages). The combined subsidence rate for all grafts was 7%. Notably, the expandable titanium cohort demonstrated a lower subsidence rate (2%) compared with the overall pooled cohort (7%), while other graft types showed no significant difference.

Conclusion: Subsidence occurred in ∼7% of patients undergoing anterior-only ACCF procedures for CSM. Notably, the use of expandable metal cages resulted in a lower rate of subsidence compared with the broader cohort. This finding suggests that these implant options may be preferable to reduce the risk of subsidence when corpectomy is necessary without posterior fixation.

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颈椎病脊髓型颈椎病单纯前路椎体切除术融合术后沉陷：系统回顾和荟萃分析。

研究设计：系统评价和荟萃分析。目的：探讨单纯前路ACCF治疗脊髓型颈椎病后体间沉降的发生及可能的影响因素。背景资料总结：脊髓型颈椎病（CSM）的手术干预通常涉及前路手术，如前路颈椎椎间盘切除术/融合（ACDF）或前路颈椎椎体切除术/融合（ACCF）。尽管移植物下沉是ACDF手术中一个公认的并发症，但关于CSM患者接受单纯前路ACCF时下沉相关因素的报道却少之又少。方法：利用PubMed、Embase、COCHRANE进行系统文献检索。该研究的纳入标准包括单纯前路颈椎椎体切除术和融合术（ACCF），这是颈椎病（CSM）的初步诊断手术。对并发症和翻修率进行定性分析。对数据进行meta分析以评估沉陷发生率，并使用meta回归分析来评估不同接枝类型之间的差异。结果：共纳入245篇摘要，34篇符合纳入标准。2500名患者在平均31个月（范围：6-56个月）的时间内被评估。基于移植物类型，以人均年发病率表示的合并沉降率如下：2%（碳纤维）、27%（同种异体腓骨支撑）、2% （nHAPA复合支撑）、5% （PEEK）、10%（静态钛）和2%（可膨胀钛保持架）。所有接枝的综合沉降率为7%。值得注意的是，可膨胀钛组的下沉率（2%）低于整体池式组（7%），而其他移植物类型没有显著差异。结论：在接受单纯前路ACCF治疗CSM的患者中，约7%发生沉陷。值得注意的是，与更广泛的队列相比，使用可膨胀金属笼的沉降率更低。这一发现表明，当需要椎体切除术而不需要后路固定时，这些植入物可以更好地减少下沉的风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Spine Surgery Medicine-Surgery

CiteScore

3.00

自引率

5.30%

发文量

236

期刊介绍： Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure. Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.