Medical Student Eastern Virginia Medical School Virginia Beach, Virginia, United States
Introduction: Deformative changes to the cervical spine are often a part of aging and can seriously burden elderly individuals. The anterior surgical approach is widely used to ventrally decompress the cervical spinal cord, restore interbody height, improve cervical lordosis, and stabilize the affected region. Anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) are most widely utilized to correct cervical deformity. However, this is no consensus as to which technique is more successful at promoting fusion and restoring cervical lordosis. The objective of this meta-analysis was to compare fusion rates, C2-C7 Cobb angle, and graft complications between ACDF and ACCF for cervical deformity.
Methods: An electronic database search was performed in MEDLINE (Ovid), EMBASE, Cochrane Library, Epistemonikos, and Scopus to identify studies where ACDF or ACCF was performed to achieve correction for cervical deformity in adult patients. Two reviewers independently screened articles and extracted data. The following variables were extracted: C2-C7 Cobb angle, fusion rate, graft dislodgement/migration, and graft subsidence. Data was analyzed using a random-effect model with RevMan 5.4
Results: 25 studies involving a cohort of 23332 patients met the inclusion criteria. The ACDF group included 20126 patients with a mean age of 55.5 years. The ACCF group included 3196 patients with a mean age of 56.8 years. The number of levels operated on ranged from 2 to 6 and 1 to 4 in the ACDF and ACCF cohorts, respectively. There was no significant difference between ACDF and ACCF in achieving fusion (P > 0.05). While there was no difference in pre-operative C2-C7 Cobb angle between cohorts (P > 0.05), ACCF was favored regarding post-operative Cobb angle (odd ratio [OR] -1.71, 95% confidence interval [CI] -3.36, -0.06). However, ACDF was better than ACCF with respect to graft subsidence (OR 2.62, 95% CI 1.34, 5.15) and graft dislodgement/migration (OR 7.87, 95% CI 1.99, 31.08).
Conclusion : ACDF and ACCF similarly achieve successful fusion in cervical deformity correction. However, ACCF more favorably improves cervical lordosis as measured by C2-C7 Cobb angle, whereas ACDF is more advantageous for minimizing the incidence of graft complications, such as graft migration, dislodgment and subsidence.
