Full-endoscopic versus microendoscopic posterior foraminotomy in the treatment of cervical radiculopathy: a Meta-analysis of perioperative complications

English Keywords:Full-endoscopic  Microendoscopic  Posterior cervical foraminotomy  Cervical radiculopathy  Meta-analysis

English Abstract:

  【Abstract】 Objectives: To systematically compare the incidence and constituent ratio of perioperative complications between full-endoscopic posterior cervical foraminotomy(FE-PCF) and microendoscopic posterior cervical foraminotomy(MI-PCF) in the treatment of cervical radiculopathy. Methods: An electronic retrieval from PubMed, Embase, Web of Science, China Biological Medicine Database(CBM), China National Knowledge Infrastructure(CNKI) and Wanfang Database was performed for available literatures published before October 2017, concerning FE-PCF and MI-PCF for cervical radiculopathy due to lateral disc herniation or foraminal stenosis. Two researchers independently conducted inclusion of eligible studies, methodological quality assessment, data extraction, classification and summarizing of complications. Comprehensive Meta Analysis 2.2 was applied for statistical analysis, incidence of complications was calculated and reported with 95% confidence intervals (CI) reported. Results: A total of 28 studies with 2060 patients, including 410 of FE-PCF and 1650 of MI-PCF, was incorporated in this study. Overall complication rates were 5.7%(CI, 3.4%-9.5%) and 3.5%(CI, 2.7%-4.6%) for the FE and MI group, respectively, with no significant difference(P=0.100). However, constituent ratio of complications showed apparent disparity with transient root palsy rated as first in the FE group(15/19, 78.9%), while dural tear(20/48, 41.7%), transient root palsy(11/48, 22.9%) and superficial wound infection (5/48, 10.4%) ranked in sequence as the top three in the MI group. In regard to subgroup analysis of individual complication, transient root palsy occurred at a higher incidence of 4.4%(CI, 2.8%-7.1%) in the FE group than 1.6%(CI, 1.0%-2.6%) in the MI group, which demonstrated statistical significance (P=0.003), whereas dural tear rate of the FE group and the MI group showed no statistical difference(FE, 1.6%; MI, 1.8%; P=0.784). Conclusions: Both FE-PCF and MI-PCF can offer safe treatment for cervical radiculopathy and there is no significant difference in overall complication rate between these two techniques. Nevertheless, transient root palsy after FE-PCF at a relatively higher incidence deserves extensive attention.