A meta-analysis of artificial total disc replacement versus fusion for lumbar degenerative disc disease

Abstract

Lumbar fusion has been developed for several decades and became the standard surgical treatment for symptomatic lumbar degenerative disc disease (DDD). Artificial total disc replacement (TDR), as an alternative for spinal arthrodesis, is becoming more commonly employed treating lumbar DDD. It is still uncertain whether TDR is more effective and safer than lumbar fusion. To systematically compare the effectiveness and safety of TDR to that of the fusion for the treatment of lumbar DDD, we performed a meta-analysis. Cochrane review methods were used to analyze all relevant randomized controlled trials published up to July 2009. Five relevant randomized controlled trials involving 837 patients were identified. Patients in TDR group have sightly better functioning and less back or leg pain without clinical significance, and significantly higher satisfaction status in TDR group compared with lumbar fusion group at the 2-year followup. But these outcomes are highly influenced by the study with BAK cage interbody fusion, the function/pain and patient satisfaction status are no longer significantly different between two groups after excluding this study. At 5 years, these outcomes are not significantly different between comparing groups. The complication and reoperation rate of two groups are similar both at 2 and at 5 years. In conclusion, TDR does not show significant superiority for the treatment of lumbar DDD compared with fusion. The benefits of motion preservation and the long-term complications are still unable to be concluded. More highquality RCTs with long-term follow-up are needed.

Clinical outcomes of single-level lumbar artificial disc replacement compared with transforaminal lumbar interbody fusion in an Asian population

“…(13) In a meta-analysis of ADR versus fusion for lumbar DDD, Yajun et al also noted better postoperative functional status (with less back and leg pain) and higher satisfaction rates in the ADR group than in the lumbar fusion group at the two-year follow-up. (21) As the measures of disability, pain and neurological status were similarly improved from baseline in both the ADR and TLIF groups at five years after treatment, some authors have concluded that ADR surgery using ProDisc-L was not inferior to fusion surgery in the treatment of single-level lumbar DDD. (22) Although the short-and mid-term results of ADR have been shown to be positive, the long-term benefit of ADR surgery over fusion surgery in lumbar DDD has not been proven conclusively.…”

Comparison of therapies in lumbar degenerative disc disease: a network meta-analysis of randomized controlled trials

“…Evidence from several studies shows that arthroplasty is superior to fusion and conservative care [18][19][20][32][33][34]. The activL Artificial Disc is the latest evolution of TDR devices for arthroplasty that further advances mechanical motion-preservation in the lumbar spine.…”

“…Across several outcomes such as disability, pain and patient satisfaction, improvements were statistically significantly in favor of TDR compared with fusion [18][19][20][32][33][34]. Furthermore, TDR was demonstrated to have either similar or improved safety compared with fusion, as typically measured by total complications, reoperation rates and adjacent segment degeneration [18][19][20][32][33][34]36,37]. When compared with conservative care, TDR showed greater improvements in disability, pain and quality of life [32].…”

Lumbar disc replacement surgery—successes and obstacles to widespread adoption

“…However, meta-analyses of randomized controlled trials (RCTs), representing the highest level of evidence, have been published to compare lumbar TDR with fusion for lumbar DDD [37][38][39][40][41]. The findings of these meta-analyses are conflicting and thereby result in uncertainty for decision makers.…”