Journal Article

Long-term survivorship of cervical spine procedures: a survivorship meta-analysis and meta-regression

Oitment, Colby, Guha, Daipayan, Hache, Philip, Pahuta, Markian, Sarraj, Mohamed

2022

نظرة عامة

Background: The aim of this study was to synthesize available data on long-term survivorship for commonly performed cervical spine procedures using cutting-edge meta-analytic techniques. Methods: A systematic review of the Ovid Medline, Embase and CENTRAL databases was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Title, abstract and fulltext screening was done in duplicate with kappa scores used to measure agreement. Only articles with cohorts of greater than 20 patients followed for a minimum of 36 months and with available survival data were included. Procedures included were anterior cervical discectomy and fusion (ACDF), cervical disc arthroplasty (CDA), laminoplasty and posterior laminectomy and fusion. Reconstructed individual patient data were pooled across studies using a Bayesian random-effects metaregression. Results: Our search identified a total of 1456 citations after exclusion of duplicates. After a full-text review of 156 titles, we included 20 studies including 8 randomized controlled trials. The total sample included 43 487 patients undergoing ACDF, 6800 patients undergoing laminoplasty, 2075 patients undergoing CDA and 32 871 patients undergoing posterior laminectomy and fusion. Our meta-regression of synthesized follow-up data with summary curves to 150 months for each of the aforementioned procedures. Posterior laminectomy and fusion was found to have significantly higher rates of secondary reoperation. At 60 months, implant survival was 94% (95% confidence interval 80%-95%) for laminoplasty, 87% (65%-96%) for laminectomy and fusion, 93% (83 %-97%) for CDA and 92% (80%-96 %) for ACDF. At 150 months, implant survival was 90% (68% -93 %) for laminoplasty, 82% (55%-92%) for laminectomy and fusion, 90% (70%-95%) for CDA and 89% (68%-93%) for ACDF. Conclusion: This is the first study to use rigorous statistical techniques to generate statistical models for time to failure of cervical spine procedures analyzing a total of over 85 000 patients. On the basis of long-term survival data from highquality publications, posterior laminectomy and fusion appears to have a significantly higher risk of secondary surgery when compared with ventral approaches or posterior laminoplasty. The granular survival curves produced by this study can be used to inform key decision-makers, counsel patients and aid in future trial design.

• الناشر: CMA Impact, Inc
• موضوع: Survivor