Anterior cervical discectomy and fusion (ACDF) versus cervical disc arthroplasty (CDA) for two contiguous levels cervical disc degenerative disease: a meta-analysis of randomized controlled trials

Zou, Shihua; Gao, Jinyang; Xu, Bin; Lu, Xiangdong; Han, Yong-bin; Meng, Hui

doi:10.1007/s00586-016-4655-5

Cited by 106 publications

(101 citation statements)

References 48 publications

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“…In two prospective, randomized, controlled trials comparing the same device with ACDF, similar mean ROM was reported at 5 years FU (10.2° and 9.3°) [22,26,31]. Likewise, this mean ROM was also in accordance with other mid-and long-term studies involving other devices which ranged from 6° to 13° [3,12,13,32]. A threshold of 2° has commonly been used to decide on the mobility of prostheses, possibly explaining why higher rates of mobility have been reported [21].…”

Section: Discussionsupporting

confidence: 86%

Clinical and radiological evaluation of cervical disc arthroplasty with 5-year follow-up: a prospective study of 384 patients

Dufour¹,

Beaurain

Huppert

et al. 2019

Eur Spine J

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Background Cervical total disc replacement was developed to avoid known complications of cervical fusion. The purpose of this paper was to provide 5-year follow-up results of an ongoing prospective study after implantation of cervical disc prosthesis. Methods Three hundred and eighty-four patients were treated using Mobi-C cervical disc (Zimmer Biomet, Troyes, France) and included in a prospective multicentre study. Routine clinical and radiological examinations were reported preoperatively and postoperatively with up to 5-year follow-up. Complications and revision surgeries were also explored. Results Results at 5 years showed significant improvement in all clinical outcomes (NDI, VAS for arm and neck pain, SF-36 PCS and MCS). Motion at index level increased significantly from 6.0° preoperatively to 8.0°, and 72.1% of the implanted segments were still mobile (referring to threshold of ROM > 3°). Proximal and distal adjacent discs showed no significant change in average motion 5 years after surgery compared to baseline. Ossification resulting in complete fusion was observed in 16.4% of the implanted segments. Distal and proximal adjacent disc degeneration occurred in 42.2% and 39.1% of patients, respectively. Complications rate was 8.9%, and 1.5% of the patients had reoperation at the index level. Surgery rate of adjacent discs was 2.9%. An increased percentage of working patients and a decrease in medication consumption were observed. At 5 years, 93.3% patients were satisfied regarding the overall outcome. Conclusions In this study, favourable 5-year follow-up clinical and radiological outcomes were observed with a low rate of adjacent level surgery.

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Section: Discussionsupporting

confidence: 86%

Clinical and radiological evaluation of cervical disc arthroplasty with 5-year follow-up: a prospective study of 384 patients

Dufour¹,

Beaurain

Huppert

et al. 2019

Eur Spine J

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“…The cohort in this study was followed for at least 5 years with a follow-up of 94% and showed a statistically significant difference in rates of reoperations in total, advantageous for ACDF. This finding is deviant to results from most previously published RCTs and meta-analyzes showing lower rates of reoperations in the ADR groups [34][35][36][37][38]. The results in our study are supported by a study presented by Nandyala et al in 2014.…”

Section: Discussioncontrasting

confidence: 51%

Higher reoperation rate following cervical disc replacement in a retrospective, long-term comparative study of 715 patients

2017

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Purpose To evaluate rates of secondary surgical interventions in a cohort treated with fusion (ACDF), artificial disc replacement (ADR) or a posterior surgical procedure (PP) because of a cervical degenerative pathology. Methods 715 patients treated with any primary cervical surgical intervention between the years 2000 and 2010 were retrospectively evaluated regarding frequency of secondary surgery between the years 2000 and 2015, thus giving a follow-up time of minimum 5 years. Reasons for secondary surgery as well as choice of new intervention were evaluated. Data were collected from a single-center setting. Results Follow-up rate was 94%. 79 (11%) patients in total underwent a new operation during follow-up. 50/504 (10%), 27/172 (15%), and 2/39 (5%) of the patients had a second surgical intervention in the ACDF, ADR, and PP groups, respectively. There was a statistically significant higher rate of repeated surgery in the ADR group compared to the ACDF group, OR 1.7 (CI 1.06-2.8), p = 0.03. Risk for repeated surgery at index level was even higher for ADR, OR 5.1 (CI 2.4-10.7), p \ 0.001. Reoperation rate because of ASD in the whole cohort did not differ between ACDF and ADR groups, p = 0.40. ConclusionThe group initially treated with artificial disc replacement showed higher rate of reoperations and more implant-related complications. In this cohort, artificial disc replacement was not protective against reoperation because of adjacent segment pathology.

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“…Whereas some results indicated that TDR was significantly superior to ACDF 6–8 regarding several clinical outcomes, other results showed no significant difference between the two treatments 9–11 . Additionally, the clinical effectiveness among TDR using different replacements and ACDF using different implants remain unresolved.…”

Section: Introductionmentioning

confidence: 94%

Indirect meta-analysis comparing clinical outcomes of total cervical disc replacements with fusions for cervical degenerative disc disease

Tian

et al. 2017

Sci Rep

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Anterior cervical discectomy and fusion (ACDF) and total cervical disc replacement (TDR) are considered effective treatments for patients with cervical degenerative disc disease (CDDD). An indirect meta-analysis including 19 randomized controlled trials (5343 patients) was conducted to compare the clinical outcomes of ACDF with TDR. Primary outcomes including functional indicators (NDI [neck disability index] score, neurological success and patient satisfaction), secondary outcomes including surgical outcomes (operation time, blood loss and length of stay) and secondary surgical procedures (secondary surgery at an adjacent level, secondary surgery at the index level, secondary surgery at both levels, removal, reoperation, revision and supplemental fixation) were included in the study. TDR using the Bryan disc was associated with a greater improvement in NDI score than ACDF (MD = −5.574, 95% CrIs [credible intervals] −11.73–−0.219). For neurological success, the Bryan (odds ratio [OR] = 0.559, 95% CrIs 0.323–0.955) and Prestige (OR = 0.474, 95% CrIs 0.319–0.700) discs were superior to ACDF. However, no differences in the patient satisfaction rate were shown between TDR and ACDF. For patients with CDDD, ACDF using allograft and a plate is most effective for determining the surgical parameters. Moreover, TDR using the ProDisc-C, Mobi-C, Prestige and Bryan discs are good choices for improving functional outcomes and reducing secondary surgeries.

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Anterior cervical discectomy and fusion (ACDF) versus cervical disc arthroplasty (CDA) for two contiguous levels cervical disc degenerative disease: a meta-analysis of randomized controlled trials

Abstract: We can learn from this meta-analysis that the cervical disc arthroplasty (CDA) group is equivalent and in some aspects has more significant clinical outcomes than the ACDF group at two contiguous levels CDD.

Cited by 106 publications

References 48 publications

Clinical and radiological evaluation of cervical disc arthroplasty with 5-year follow-up: a prospective study of 384 patients

Clinical and radiological evaluation of cervical disc arthroplasty with 5-year follow-up: a prospective study of 384 patients

Higher reoperation rate following cervical disc replacement in a retrospective, long-term comparative study of 715 patients

Indirect meta-analysis comparing clinical outcomes of total cervical disc replacements with fusions for cervical degenerative disc disease

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