POSTOPERATIVE FUNCTIONAL EVALUATION OF ACDF VERSUS PCDF IN DCM: A SYSTEMATIC REVIEW AND META-ANALYSIS

ABSTRACT This study aimed to evaluate the functional improvement of the neck when comparing anterior cervical decompression techniques with fusion and posterior decompression techniques with fusion. The review followed PRISMA guidelines and included a comprehensive search of PubMed, Scopus, EMBASE, Web of Science, LILACS, and gray literature databases. Intervention studies (randomized and non-randomized clinical trials) reporting postoperative functional assessment using the Neck Disability Index (NDI) in patients with degenerative cervical myelopathy undergoing one of two surgical approaches were selected. The risk of bias was assessed using the Cochrane Risk of Bias 2.0 (ROB 2.0) tools for randomized clinical trials and ROBINS-I for non-randomized studies. The meta-analysis was carried out to assess the functional improvement associated with each technique. Of the 1,311 studies identified, four met the eligibility criteria and were included in the qualitative and quantitative analysis, totaling 542 patients. Of these, 292 (53.9%) underwent the anterior surgical approach and 250 (46.1%) the posterior approach. After one year’s follow-up, approximately 96% of patients who underwent the anterior approach had a reduction in NDI from 35.75±6.02 to 16.56±4.96, while around 93% of patients who underwent the posterior approach had an improvement from 35.70±6.10 to 20.25±8.13. The meta-analysis found no statistically significant difference between the approaches in terms of postoperative functional improvement (p = 0.47). The findings of this study suggest that both techniques provide similar functional benefits, with a tendency towards faster recovery in the former approach, as evidenced by a more marked reduction in NDI and VAS in this group. Level of Evidence II; Systematic Review of Level II or Level I studies with heterogeneous results.