Quality assessment of systematic reviews of surgical treatment of cervical spine degenerative diseases: an overview

ABSTRACT Objective To gather all systematic reviews of surgical treatment of degenerative cervical diseases and assess their quality, conclusions and outcomes. Methods A literature search for systematic reviews of surgical treatment of degenerative cervical diseases was conducted. Studies should have at least one surgical procedure as an intervention. Included studies were assessed for quality through Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) and Assessment of Multiple Systematic Reviews (AMSTAR) questionnaires. Quality of studies was rated accordingly to their final score as very poor (<30%), poor (30%-50%), fair (50%-70%), good (70%-90%), and excellent (>90%). If an article reported a conclusion addressing its primary objective with supportive statistical evidence for it, they were deemed to have an evidence-based conclusion. Results A total of 65 systematic reviews were included. According to AMSTAR and PRISMA, 1.5% to 6.2% of studies were rated as excellent, while good studies counted for 21.5% to 47.7%. According to AMSTAR, most studies were of fair quality (46.2%), and 6.2% of very poor quality. Mean PRISMA score was 70.2%, meaning studies of good quality. For both tools, performing a meta-analysis significantly increased studies scores and quality. Cervical spondylosis studies reached highest scores among diseases analyzed. Authors stated conclusions for interventions compared in 70.7% of studies, and only two of them were not supported by statistical evidence. Conclusion Systematic reviews of surgical treatment of cervical degenerative diseases present “fair” to “good” quality in their majority, and most of the reported conclusions are supported by statistical evidence. Including a meta-analysis significantly increases the quality of a systematic review.

摘要
目的：系统收集退行性颈椎疾病外科治疗相关的全部系统评价，并对其研究质量、结论与研究结果进行评估。
方法：针对退行性颈椎疾病外科治疗相关的系统评价开展文献检索。纳入研究需至少包含1种外科术式作为干预措施。采用系统评价与Meta分析优先报告条目（Preferred Reporting Items for Systematic Review and Meta-analysis, PRISMA）及多种系统评价评价工具（Assessment of Multiple Systematic Reviews, AMSTAR）对纳入研究的质量进行评价。根据最终得分将研究质量划分为极差（<30%）、较差（30%~50%）、一般（50%~70%）、良好（70%~90%）及优秀（>90%）五个等级。若某文献报告了针对其主要研究目的的结论，并配有支持性统计证据，则认定该研究具备循证结论。
结果：共纳入65篇系统评价。基于AMSTAR与PRISMA评分标准，1.5%~6.2%的研究被评为优秀，21.5%~47.7%的研究被评为良好。基于AMSTAR评分，多数研究质量为一般（46.2%），6.2%的研究质量为极差。PRISMA平均得分为70.2%，提示研究整体质量为良好。两种评价工具均显示，开展Meta分析可显著提升研究得分与研究质量。在本次分析纳入的各类疾病相关研究中，颈椎病相关研究得分最高。70.7%的研究报告了其所比较的干预措施的结论，其中仅2项研究的结论未得到统计证据支持。
结论：退行性颈椎疾病外科治疗相关系统评价的整体质量多处于“一般”至“良好”水平，多数报告的结论均有统计证据支持。开展Meta分析可显著提升系统评价的研究质量。