Evidence map›Paper›PMID 42340435›Full record

SynthesisEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026

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, Regan Elbert, Jephtah Furano Lumban Tobing

Abstract readSystematic ReviewMeta-Analysis
PubMed Publisher
In one paragraph

Synthesis in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Alexander Erick PurnomoDepartment of Medicine, Faculty of Medicine, Pelita Harapan University, Tangerang, Indonesia. alexandererick771@gmail.com.ORCID http://orcid.org/0000-0001-9284-7732
Aldi Nanda KurniawanDepartment of Medicine, Faculty of Medicine, Pelita Harapan University, Tangerang, Indonesia.
Yang Yang Endro ArjunaDepartment of Medicine, Faculty of Medicine, Pelita Harapan University, Tangerang, Indonesia.ORCID http://orcid.org/0000-0002-5916-1453
Regan ElbertDepartment of Medicine, Faculty of Medicine, Pelita Harapan University, Tangerang, Indonesia.ORCID http://orcid.org/0009-0005-4174-0704
Jephtah Furano Lumban TobingDepartment of Medicine, Faculty of Medicine, Pelita Harapan University, Tangerang, Indonesia. jephtah.tobing@uph.edu.ORCID http://orcid.org/0000-0003-0677-4026

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeExcessive distraction (ED) during anterior cervical spine surgeries may improve cervical alignment but higher the risk of postoperative complications. To date, no comprehensive reviews has evaluated the overall impacts of ED across anterior cervical spine surgeries. This study aims to evaluate the impact of excessive distraction (ED) on clinical and radiological outcomes during anterior cervical spine surgeries.

methodsA systematic search (PubMed, Europe PMC, Embase, Scopus, Google Scholar; up to March 2025) identified studies reporting distraction and postoperative outcomes after ACDF or CDR. Studies without clinical/radiological outcomes, incomplete statistical reporting, case reports or animal and cadaveric studies were excluded. Data were stratified into early (< 6 months) and late (≥ 6 months) post-operative. Meta-analyses were conducted using Cochrane Review Manager 5.4.1 and R-Studio 4.5.2.

resultsA total of 19 cohort studies encompassing of 1877 patients were included. Excessive distraction was associated with greater post operative neck pain (nVAS: early SMD 0.46; late SMD 0.4, both p < 0.00001), arm pain (aVAS: early SMD 0.28, p = 0.007; late SMD 0.36, p = 0.004), and disability (NDI: early SMD 0.28, p = 0.002; late SMD 0.46, p < 0.00001). No significant differences were found in mJOA or SF-36 scores. Radiologically, ED improved cervical lordosis (C2-C7 Cobb angle: SMD 0.27, p = 0.0005) and range of motion (SMD 0.62, p < 0.00001). However, ED increases risks of adjacent segment degeneration (ASD) (RR 2.98, p < 0.00001), cage subsidence (RR 1.63, p < 0.00001) and heterotopic ossification (HO) (RR 1.99, p = 0.009).

conclusionExcessive distraction in anterior cervical spine surgeries improves cervical alignment and mobility but worsens pain, disability, and long-term complications. Optimal, not maximal distraction should be targeted to balance alignment benefits with functional outcomes and mechanical safety.

Indexed as

Cervical VertebraePostoperative ComplicationsSpinal FusionHumansTreatment OutcomeAnterior cervical spine surgeriesClinical outcomesComplicationsExcessive distractionRadiological outcomes

Identifiers

PMID42340435

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.