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Advantages of 3-dimensional exoscope-assisted anterior cervical spine surgery: A meta-analysis

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Abstract

Background

Visual instruments are essential to ensure high-quality surgical outcomes for minimally invasive procedures and have gradually become the focus of research. Recently, a novel visual auxiliary instrument, a 3-dimensional exoscope (EX), has been applied for spinal surgery. However, its advantages over other auxiliary means (OAMs) in anterior cervical surgery need to be assessed.

Objective

To compare and evaluate the clinical outcomes of EX and OAMs in anterior cervical spine surgery using a meta-analysis and to provide the latest clinical evidence.

Methods

PubMed, Embase, Cochrane Library, Web of Science, CNKI, and Wanfang Database were systematically reviewed for relevant literature published prior to January 21, 2023. Two researchers independently screened the literature, extracted data, and assessed bias risk in the included literature. Review Manager software (version 5.4; the Cochrane Collaboration) was used to conduct the meta-analysis.

Results

five studies, one prospective and four retrospective cohort studies, with a total of 349 patients (154 in the EX group and 195 in the OAMs group) were included. A meta-analysis showed that compared to OAMs, EX-assisted anterior cervical spine surgery resulted in less intraoperative hemorrhage [WMD = -8.96, 95% CI (-14.21, -3.71), P = 0.0008]. Nevertheless, no significant differences in VAS scores, JOA scores, operation time, hospitalization time, and complication rate were observed between the two groups (P > 0.05).

Conclusion

EX and OAMs are equally safe and effective for anterior cervical spine surgery; however, compared to OAMs, EX results in less intraoperative hemorrhage.

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Data Availability

The datasets used and analysed during the current study available from the corresponding author on reasonable request.

Abbreviations

ACDF:

Anterior cervical discectomy and fusion

ACCF:

Anterior cervical corpectomy and fusion

ACDR:

Artificial cervical disc replacement

CI:

Confidence interval

EX:

3-Dimensional Exoscope

JOA:

Japanese Orthopaedic Association

NDI:

Neck Disability Index

OM:

Operating microscope

OAMs:

Other auxiliary means

RCTs:

Randomized controlled trials

VAS:

Visual Analog Scale

WMD:

Weighted mean differences

RULA:

Rapid upper limb assessment

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Funding

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Authors and Affiliations

  1. Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China

    Fuhao Lei, Yizhou Xie, Jin Fu & Zhe Xie

  2. Chongqing Medical University, Chongqing, China

    Miaosheng Zhang

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  1. Fuhao Lei
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Correspondence to Yizhou Xie.

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Lei, F., Xie, Y., Fu, J. et al. Advantages of 3-dimensional exoscope-assisted anterior cervical spine surgery: A meta-analysis. Acta Neurochir 165, 3077–3087 (2023). https://doi.org/10.1007/s00701-023-05721-4

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