A Meta-analysis of the effectiveness and safety of ultrasonic bone curette versus high-speed drill in the treatment of cervical expansive open-door laminoplasty

English Keywords:Cervical vertebrae  Cervical expansive open-door laminoplasty  Ultrasonic bone curette  High-speed drill  Meta-analysis

English Abstract:

  【Abstract】 Objectives: To evaluate the efficacy and safety of ultrasonic bone curette(UBC) versus high-speed drill(HSD) in cervical expansive open-door laminoplasty(CEOL) by a Meta-analysis approach. Methods: An extensive computer search was conducted in the database of PubMed, Embase, Web of Science, Wanfang and CNKI, and a comparative clinical study comparing the efficacy and safety of UBC versus HSD in cervical expansive open-door laminoplasty was collected. The retrieval period is from the beginning of database building to March 2021. Two researchers independently screened the literature, extracted data, and assessed the risk of bias included in the study, then performed a meta-analysis using the Revman 5.3 software provided by the Cochrane Library. Results: A total of 631 patients were ultimately included in 8 clinical trials, including 4 randomized controlled trials(RCT) and 4 cohort studies(CS), of which 314 were in the UBC group and 317 were in the HSD group. Meta-analysis showed that there was no significant difference in JOA score, VAS score, overall complication rate, axial symptom and C5 nerve root palsy rate between the two groups(P＞0.05). However, compared with the HSD group, the UBC group had surgery time [mean difference(MD)=-24.78, 95%CI（-36.80, -12.76), P<0.0001], intraoperative bleeding volume[MD=-69.94, 95%CI(-115.40, -24.47), P=0.003], postoperative drainage flow[MD=-53.21, 95%CI(-86.95, -19.46), P=0.002], incidence of dural tear[OR=0.30, 95%CI(0.09, 0.95), P=0.04] and incidence of cerebrospinal fluid leakage[odds ratio(OR)=0.30, 95%CI(0.09, 0.95), P=0.04] were significantly lower than those of the HSD group. Conclusions: It is safe and effective to use UBC in cervical expansive open-door laminoplasty, which can save operation time, reduce blood loss and postoperative drainage, reduce the risk of dural tear and cerebrospinal fluid(CSF) leak.