Effects of excessive distraction during anterior cervical spine surgery: a systematic review and meta-analysis of clinical outcomes, radiological changes, and complications.
Alexander Erick Purnomo, Aldi Nanda Kurniawan, Yang Yang Endro Arjuna et al.
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In 30 seconds
This systematic review and meta-analysis evaluated the effects of excessive distraction (ED) during anterior cervical spine surgeries in 1877 patients. While ED improved cervical alignment and range of motion, it was associated with increased postoperative neck and arm pain, disability, and a higher risk of complications such as adjacent segment degeneration and cage subsidence. The study highlights the need for optimal distraction to balance benefits and risks.
Key findings
- Excessive distraction increased postoperative neck pain (early SMD 0.46; late SMD 0.4, p < 0.00001).
- Arm pain was also higher with excessive distraction (early SMD 0.28, p = 0.007; late SMD 0.36, p = 0.004).
- The risk of adjacent segment degeneration was nearly tripled (RR 2.98, p < 0.00001) with excessive distraction.
- Cervical lordosis improved with excessive distraction (C2-C7 Cobb angle: SMD 0.27, p = 0.0005).
Why it matters
Understanding the balance between alignment benefits and the risks of complications is crucial for clinicians performing anterior cervical spine surgeries. This study provides evidence to guide surgical techniques and patient counseling regarding potential outcomes.