Data_Sheet_1_Clinical Efficacy and Safety of Surgical Treatments in Patients With Pure Cervical Radiculopathy.docx

BackgroundTraditionally paired meta-analysis revealed inconsistencies in the safety and effectiveness of surgical interventions. We conducted a network meta-analysis to assess various treatments' clinical efficacy and safety for pure cervical radiculopathy.
MethodsThe Embase, PubMed, and Cochrane Library databases were searched for randomized controlled trials (RCTs) comparing different treatment options for patients with pure cervical radiculopathy from inception until October 23, 2021. The primary outcomes were postoperative success rates, postoperative complication rates, and postoperative reoperation rates. The pooled data were subjected to a random-effects consistency model. The protocol was published in PROSPERO (CRD42021284819).
ResultsThis study included 23 RCTs (n = 1,844) that evaluated various treatments for patients with pure cervical radiculopathy. There were no statistical differences between treatments in the consistency model in terms of major clinical effectiveness and safety outcomes. Postoperative success rates were higher for anterior cervical foraminotomy (ACF: probability 38%), posterior cervical foraminotomy (PCF: 24%), and anterior cervical discectomy with fusion and additional plating (ACDFP: 21%). Postoperative complication rates ranked from high to low as follows: cervical disc replacement (CDR: probability 32%), physiotherapy (25%), ACF (25%). Autologous bone graft (ABG) had better relief from arm pain (probability 71%) and neck disability (71%). Among the seven surgical interventions with a statistical difference, anterior cervical discectomy with allograft bone graft plus plating (ABGP) had the shortest surgery time.
ConclusionsAccording to current results, all surgical interventions can achieve satisfactory results, and there are no statistically significant differences. As a result, based on their strengths and patient-related factors, surgeons can exercise discretion in determining the appropriate surgical intervention for pure cervical radiculopathy.
Systematic Review Registration: CRD42021284819.

背景：传统成对meta分析在手术干预的安全性与有效性方面存在结果不一致的问题。本研究开展网状meta分析，以评估各类治疗方案针对单纯性神经根型颈椎病的临床疗效与安全性。
方法：检索Embase、PubMed及Cochrane Library数据库，自建库起至2021年10月23日止，纳入对比各类治疗方案用于单纯性神经根型颈椎病患者的随机对照试验（randomized controlled trial, RCT）。本研究的主要结局指标包括术后成功率、术后并发症发生率及术后再手术率。合并数据采用随机效应一致性模型进行分析。本研究方案已在PROSPERO平台注册（注册号：CRD42021284819）。
结果：本研究共纳入23项RCT，共计1844例患者，评估了各类治疗方案用于单纯性神经根型颈椎病患者的疗效。一致性模型分析显示，不同治疗方案在主要临床疗效与安全性结局指标上均无统计学差异。术后成功率较高的术式依次为颈椎前路椎间孔切开术（anterior cervical foraminotomy, ACF：概率38%）、颈椎后路椎间孔切开术（posterior cervical foraminotomy, PCF：24%）及颈椎前路椎间盘切除融合加钢板内固定术（anterior cervical discectomy with fusion and additional plating, ACDFP：21%）。术后并发症发生率由高到低排序为：颈椎间盘置换术（cervical disc replacement, CDR：32%）、物理治疗（25%）、ACF（25%）。自体骨移植（autologous bone graft, ABG）在缓解上肢疼痛（概率71%）与颈部功能障碍（71%）方面效果更优。在存在统计学差异的7种手术干预措施中，颈椎前路异体骨移植椎间盘切除融合钢板内固定术（anterior cervical discectomy with allograft bone graft plus plating, ABGP）的手术时长最短。
结论：基于本研究结果，所有手术干预方案均可获得满意疗效，且相互间无统计学差异。因此，外科医生可结合各术式的优势与患者个体相关因素，自主选择适配单纯性神经根型颈椎病患者的手术治疗方案。
系统评价注册：CRD42021284819。