Safety and Efficacy of Anterior Cervical Discectomy and Fusion with Uncinate Process Resection: A Systematic Review and Meta-Analysis

STUDY DESIGN: This is a meta-analysis and systematic review of the available literature. OBJECTIVE: In the case of severe foraminal stenosis, conducting uncinate process resection (UPR) during ACDF could achieve complete nerve root decompression and significant relief of neurological symptoms for CR. However, there is some controversy regarding its necessity and safety. This study aims to compare the safety and efficacy of ACDF with UPR and ACDF. METHODS: The following electronic databases were searched: Medline, PubMed, Embase, the Cochrane Central Register of Controlled Trials, Evidence Based Medicine Reviews, VIP, and CNKI. And the following data items were considered: baseline demographics, efficacy evaluation indicators, radiographic outcome, and surgical details. RESULTS: 10 studies were finally identified, including 746 patients who underwent ACDF with UPR compared to 729 patients who underwent ACDF. The group of ACDF with UPR had statistically longer intraoperative time (95% CI: 4.83, 19.77, P = .001) and more intraoperative blood loss (95% CI: 12.23, 17.76, P < .001). ACDF with UPR obtained a significantly better improvement of Arm VAS at postoperative first follow-up (95% CI: −1.85, −.14 P = .02). There was no significant difference found in improvement of Neck VAS at postoperative latest follow-up (95% CI: −.88, .27, P = .30), improvement of Arm VAS at postoperative latest follow-up (95% CI: −.59, −.01, P = .05), improvement of NDI (95% CI: −2.34, .33, P = .14), JOA (95% CI: −.24, .43, P = .56), change of C2-C7 lordosis (95% CI: −.87, 1.33, P = .68), C2-C7 SVA (95% CI: −.73, 5.08, P = .14), T1 slope (95% CI: −2.25, 1.51, P = .70), and fusion rate (95% CI: .83, 1.90 P = .29). CONCLUSION: ACDF with UPR is an effective and necessary surgical method for CR patients with severe foraminal stenosis.