RESUMO
BACKGROUND:Many studies concern the comparison of posterior laminectomy and instrumented fusion and posterior laminoplasty for multilevel cervical spondylotic myelopathy, but the sample size of many studies has limitations. There is lack of objective evaluation on advantages and disadvantages of two surgical methods. OBJECTIVE:To compare the efficacy and safety of posterior laminectomy and instrumented fusion and laminoplasty in the treatment of multilevel cervical spondylotic myelopathy. METHODS:A systematic search of al the studies published was conducted on the PubMed, Cochrane Central, EMbase, the ISI Web of Knowledge Database, CMB, CNKI, VIP and Wanfang databases. Randomized and non-randomized control ed trials that compared between posterior laminectomy and instrumented fusion and laminoplasty for multilevel cervical spondylotic myelopathy were identified. Meta-analyses were performed in postoperative Japanese Orthopaedic Association scores, cervical range of motion, cervical curvature index, incidence of C5 nerve root paralysis and incidence of axial symptoms. RESULTS AND CONCLUSION:(1) Fourteen studies involving 1 024 patients were included. Among the patients, 519 underwent laminectomy and instrumented fusion and 505 underwent laminoplasty. (2) The results of the meta-analysis indicated that, compared with laminectomy and instrumented fusion group, laminoplasty group had advantages of a lower incidence of C5 palsy [RR=2.24, 95%CI(1.33,3.75), Z=3.05, P<0.05] and smal degree of cervical rotation injury [SMD=-0.71, 95%CI(-2.21,-1.2), Z=6.63, P<0.05]. However, the two groups had no statistical difference in postoperative Japanese Orthopaedic Association score, cervical curvature index and the incidence of axial symptoms. (3) These results suggested that both laminectomy and instrumented fusion and laminoplasty were demonstrated to be effective for multilevel cervical spondylotic myelopathy. Laminoplasty had obvious advantages of decreasing the degree of cervical rotation injury and lowering incidence of C5 palsy. However, in the process of clinical diagnosis and treatment, the patient’s condition should be combined. The long-term clinical efficacy of the technology needs more clinical work to confirm.
RESUMO
BACKGROUND:At present, the clinical treatment of lumbar disc degeneration mainly includes conservative treatment, traditional surgery and minimal y invasive surgery. The therapeutic purpose is to relieve symptoms, but the long-term effect is not very satisfactory. Therapeutic methods focusing on biological functional recovery have been concerned gradual y, but the clinical application is far in sight. OBJECTIVE:To review the advances in the treatment of lumbar disc degeneration regarding tissue-engineered repair and biomechanics. METHODS:PubMed database was searched by the first author for relevant articles published before December 2014 using the keywords of“intervertebral disc degeneration, clinical treatment, biological treatment, tissue engineering, biomechanics, repair, progress”in English. A total of 100 articles were searched initial y and final y, 40 articles were included in result analysis. RESULTS AND CONCLUSION:Although the therapeutic schemes are varied, the treatment of intervertebral disc degeneration is a great chal enge for clinicians and basic researchers. Currently there is no perfect clinical treatment, and indications corresponding to various therapies should be paid attention as wel as long-term fol ow-up evaluation. For various reasons, the biological treatment for intervertebral disc degenerative disease is becoming more and more popular, providing a promising prospect for the treatment of intervertebral disc degeneration. So far, large amounts of data have been obtained from animal experiments, but there are stil many problems to be solved. Other chal enges also involve the al aspects of general tissue engineering methods, such as cel s, cytokines and scaffolds. In these studies, the nucleus pulposus tissue engineering based on the combination of heparin-functionalized chitosan hydrogel, cytokines and stem cel s exhibits a promising prospect.