Anterior cervical discectomy with arthroplasty versus anterior cervical discectomy and fusion for cervical spondylosis

Li, Gao-Ling; Hu, Jianzhong; Lü, Hongbin; Guo, Li-Yun; Zai, Feng-Lei

doi:10.1016/j.jocn.2014.09.010

Cited by 12 publications

(8 citation statements)

References 36 publications

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“…There was conflicting evidence for reoperation rates. In meta-analyses regarding CDR and ACDF in general cervical degenerative disorders, comparable or more favorable results have been reported for CDR 8,10,11,14,16,18,20,22,50 .…”

Section: Cdrmentioning

confidence: 69%

“…Multiple reviews and meta-analyses have been published comparing one surgical technique with another; however, in most studies, the localization of the degenerative disease was not clearly stated. Furthermore, patients presenting with myelopathy and/or radicular symptoms were often combined, which may lead to undesired heterogeneity in the study population [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] . Therefore, a comprehensive systematic review investigating the effectiveness of surgery for patients with pure cervical radiculopathy is needed.…”

mentioning

confidence: 99%

“…T H E J O U R N A L O F B O N E & JOINT SURGERY d J B J S . O R G VOLUME 102-A d N U M B E R 24 d D E C E M B E R16, 2020 …”

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confidence: 99%

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Surgical Interventions for Cervical Radiculopathy without Myelopathy

Broekema

Groen

Souza

et al. 2020

Journal of Bone and Joint Surgery

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Background: The effectiveness of surgical interventions for cervical degenerative disorders has been investigated in multiple systematic reviews. Differences in study population (e.g., patients with myelopathy and/or radiculopathy) were often neglected. Therefore, the objective of this study was to investigate the effectiveness of surgical interventions for patients with symptoms of cervical radiculopathy without myelopathy by conducting a systematic review and metaanalysis based on randomized controlled trials (RCTs).Methods: A comprehensive systematic search was conducted in MEDLINE, Embase, and CENTRAL (Cochrane Central Register of Controlled Trials) to identify RCTs that investigated the effectiveness of surgical interventions using an anterior or posterior approach compared with other interventions for patients with pure cervical radiculopathy. Outcomes were success rates (Odom criteria, similar rating scales, or percentage of patients who improved), complication and reoperation rates, work status, disability (Neck Disability Index), and pain (arm and neck). The Cochrane risk-of-bias tool was used to assess the likelihood of the risk of bias. A random-effects model was used. Heterogeneity among study results (I 2 ‡ 50% or p < 0.05) was explored by conducting subgroup analyses. Funnel plots were used to assess the likelihood of publication bias.Results: A total of 21 RCTs were included, comprising 1,567 patients. For all outcomes, among all surgical techniques, Disclosure: The authors indicated that no external funding was received for any aspect of this work. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/G80).

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Section: Cdrmentioning

confidence: 69%

mentioning

confidence: 99%

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Surgical Interventions for Cervical Radiculopathy without Myelopathy

Broekema

Groen

Souza

et al. 2020

Journal of Bone and Joint Surgery

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“…A few previous meta-analyses (Fallah et al 2012 ; Gao et al 2013 , 2015 ; Jiang et al 2012 ; Luo et al 2015a , b ; Li et al 2015 ; Muheremu et al 2015 ; Rao et al 2015 ; Ren et al 2014 ; Shriver et al 2015 ; Verma et al 2013 ; Wu et al 2015 ; Xing et al 2013 ; Yao et al 2015 ; Yin et al 2013 ; Yang et al 2012 ; Yu et al 2011 ; Zhu et al 2016 ; Zhong et al 2016 ) have focused on this problem, but they have different conclusions about whether CDA is superior to CDA in treating CDDDs (Table 1 ). They used single-site data which is part of a multicenter trial or missed some important data.…”

Section: Introductionmentioning

confidence: 99%

Cervical disc arthroplasty (CDA) versus anterior cervical discectomy and fusion (ACDF) in symptomatic cervical degenerative disc diseases (CDDDs): an updated meta-analysis of prospective randomized controlled trials (RCTs)

et al. 2016

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PurposeThis meta-analysis of randomized controlled trials (RCTs) aims to evaluate the efficacy and safety in cervical disc arthroplasty (CDA) and anterior cervical discectomy and fusion (ACDF) for treating cervical degenerative disc diseases (CDDDs).MethodsThe authors searched RCTs in the electronic databases (Cochrane Central Register of Controlled Trials, PubMed, EMBASE, Medline, Embase, Springer Link, Web of Knowledge, OVID and Google Scholar) from their establishment to march 2016 without language restrictions. We also manually searched the reference lists of articles and reviews for possible relevant studies. Researches on CDA versus ACDF in CDDDs were selected in this meta-analysis. The quality of all studies was assessed and effective data was pooled for this meta-analysis. Outcome measurements were surgical parameters (operative time, blood loss, and length of hospital stay), clinical indexes [neck disability index (NDI), neurological success, range of motion (ROM), Visual Analogue Score (VAS)], complications [the number of adverse events, adjacent segment disease (ASD), and reoperation]. Subgroup analysis, sensitivity analysis, and publication bias assessment were also performed, respectively. The meta-analysis was performed with software revman 5.3.Results37 articles (20 RCTs) with a total 4004 patients (2212 in the CDA and 1792 in the ACDF) met inclusion criteria. Eight types of disc prostheses were used in the included studies. Patients were followed up for at least 2 years in all the studies. No statistically significant differences were found between CDA and ACDF for blood loss [SMD −0.02; 95 % CI (−0.20, 0.17)], length of hospital stay [MD −0.06; 95 % CI (−0.19, 0.06)]. Statistical differences were found between operative time [MD 14.22; 95 % CI (6.73, 21.71)], NDI [SMD −0.27; 95 % CI (−0.43, −0.10)], neurological success [RR 1.13; 95 % CI (1.08, 1.18)], ROM [MD 6.72; 95 % CI (5.72, 7.71)], VAS of neck [SMD −0.40; 95 % CI (−0.75, −0.04)], VAS of arm [SMD −0.55; 95 % CI (−1.04, −0.06)], the rate of adverse events [RR 0.72 95 % CI (0.53, 0.96)], the rate of ASD [RR 0.62; 95 % CI (0.43, 0.88)], and reoperation [RR 0.50; 95 % CI (0.39, 0.63)]. Subgroup analysis stratified by different types of disc prostheses was also performed.ConclusionsCDA is associated with higher clinical indexes and fewer complications than ACDF, indicating that it is a safe and effective treatment for CDDDs. However, the operative time of CDA is longer than ACDF. Because of some limitations, these findings should be interpreted with caution. Additional studies are needed. Large, definitive RCTs are needed.

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“…There are several studies reporting that TDR (total disk replacement) has the similar or even better therapeutic effect than ACDF. However, there is consensus on the better approach for cervical spondylosis [ 4 – 6 ]. In the current study, we have retrospectively reviewed the clinical materials of patients who received either ACDF or TDR for the treatment of single level cervical disk herniation, and had follow up visits for 8 years.…”

Section: Introductionmentioning

confidence: 99%

ACDF vs TDR for patients with cervical spondylosis – an 8 year follow up study

et al. 2017

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BackgroundACDF has been considered as the gold standard in the treatment of single level cervical disk protrusion. However, it may cause adjacent level degeneration due to regional biomechanical changes. TDR has been applied with satisfactory results for over a decade, but there is no consensus if TDR is safer and more efficient than ACDF. The current study was carried out to compare the efficiency and safety of TDR and ACDF in the treatment of patients with single level cervical disk protrusion.MethodsOne hundred forty-five consecutive patients who underwent either TDR or ACDF in our center were included in the current study. Time of surgery, intraoperative blood loss, VAS arm and neck pain scores, ROM, ODI, SF36 and Patient satisfaction were compared before the surgery, after the surgery, and during follow up 1, 3, 5, 8 years after the surgery.ResultsThe time of surgery was 64.6 ± 20.7 min in the ACDF group and 69.4 ± 19.3 min in the TDR group; intraoperative hemorrhage was 67.2 ± 14.3 ml in ACDF group and 70.7 ± 18.6 ml in TDR group. There were no significant differences between two groups concerning time of surgery and intraoperative blood loss. No differences were found concerning patient satisfaction between the two groups during the follow up (P > 0.05). Significant differences were found between the groups concerning VAS arm and neck pain scores, ROM, ODI and SF36 after the surgery and during the 8 year follow up.ConclusionTDR may be a more effective approach than ACDF for treating patients with single level cervical disk protrusion.KeywordsCervical disk herniation, ACDF, TDR, Retrospective study

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Anterior cervical discectomy with arthroplasty versus anterior cervical discectomy and fusion for cervical spondylosis

Cited by 12 publications

References 36 publications

Surgical Interventions for Cervical Radiculopathy without Myelopathy

Surgical Interventions for Cervical Radiculopathy without Myelopathy

Cervical disc arthroplasty (CDA) versus anterior cervical discectomy and fusion (ACDF) in symptomatic cervical degenerative disc diseases (CDDDs): an updated meta-analysis of prospective randomized controlled trials (RCTs)

ACDF vs TDR for patients with cervical spondylosis – an 8 year follow up study

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