Safety and Efficacy of Anterior Cervical Corpectomy and Reconstruction With Expandable Cages for Treatment of Cervical Myelopathy-Focusing on Stand-Alone Cages: A Systematic Review and Meta-Analysis.

Abstract

Study DesignSystematic review and Meta-analysis.ObjectivesThis study aims to evaluate the efficacy, postoperative outcomes, and potential complications of using expandable cages in cervical spine surgery.MethodsA comprehensive search was performed across Medline, Scopus, Web of Science, Cochrane, and Embase up to May 22, 2023. Meta-analyses and subgrouping analyses were performed using "OpenMetaAnalyst" and R software to analyze efficacy outcomes and complications. The assessment of heterogeneity utilized the i² and chi-squared tests, applying the random effect model.ResultsThirty studies were included, with 22 eligible for meta-analysis. The pooled data showed a significant improvement in the Cobb angle, Nurick's score and modified Japanese Orthopedic Association (mJOA) score. The pooled stability rate post-surgery was 0.94 based on 7 studies, but the stand-alone cages showed a lower stability rate (0.83). Fusion rate showed high success at 0.94 across 14 studies but also the fusion rate in the stand-alone group was lower (0.89) with substantial heterogeneity (I² = 91.81%) suggests that stand-alone cages may not consistently achieve the same level of fusion as cages with anterior plating (fusion rate of 0.98, I² = 0%). Dysphagia was observed in 16% of patients, and hardware-related issues were reported in 9% of cases.Conclusionsexpandable cages offer significant advantages in terms of fusion, stability, and neurological recovery. In particular, stand-alone expandable cages were associated with higher rates of complications, including dysphagia, subsidence, and hardware failure, compared to cages with anterior plating.