Comparison of anterior cervical discectomy and fusion versus artificial disc replacement for cervical spondylotic myelopathy: a meta-analysis

Abstract

OBJECTIVE Anterior cervical discectomy and fusion (ACDF) has long been regarded as a gold standard in the treatment of cervical myelopathy. Subsequently, cervical artificial disc replacement (c-ADR) was developed and provides the advantage of motion preservation at the level of the intervertebral disc surgical site, which may also reduce stress at adjacent levels. The goal of this study was to compare clinical and functional outcomes in patients undergoing ACDF with those in patients undergoing c-ADR for cervical spondylotic myelopathy (CSM). METHODS A systematic literature review and meta-analysis were performed using the Embase, PubMed, and Cochrane Central Register of Controlled Trials databases from database inception to November 21, 2021. The authors compared Neck Disability Index (NDI), SF-36, and Japanese Orthopaedic Association (JOA) scores; complication rates; and reoperation rates for these two surgical procedures in CSM patients. The Mantel-Haenszel method and variance-weighted means were used to analyze outcomes after identifying articles that met study inclusion criteria. RESULTS More surgical time was consumed in the c-ADR surgery (p = 0.04). Shorter hospital stays were noted in patients who had undergone c-ADR (p = 0.04). Patients who had undergone c-ADR tended to have better NDI scores (p = 0.02) and SF-36 scores (p = 0.001). Comparable outcomes in terms of JOA scores (p = 0.24) and neurological success rate (p = 0.12) were noted after the surgery. There was no significant between-group difference in the overall complication rates (c-ADR: 18% vs ACDF: 25%, p = 0.17). However, patients in the ACDF group had a higher reoperation rate than patients in the c-ADR group (4.6% vs 1.5%, p = 0.02). CONCLUSIONS At the midterm follow-up after treatment of CSM, better functional outcomes as reflected by NDI and SF-36 scores were noted in the c-ADR group than those in the ACDF group. c-ADR had the advantage of retaining range of motion at the level of the intervertebral disc surgical site without causing more complications. A large sample size with long-term follow-up studies may be required to confirm these findings in the future.

Impact of Preoperative 12-item Short Form Mental Composite Scores on Clinical Outcomes in Cervical Disc Replacement

“…2,23 As such, the combination of preserved range of motion and elimination of pain/weakness from neural decompression may explain the improvement in physical function in both cohorts. 24,25 With MCID, the non-depressed cohort had most patients achieve overall MCID in both physical function parameters, with a higher proportion of MCID achievement at 12-week PROMIS-PF, whereas the depressed cohort had most patients achieve MCID only in PROMIS-PF. Overall, these findings suggest that CDR may be more effective in improving physical function in patients with better mental health in the intermediate postoperative period; however, these differences in physical function disappear in the long-term.…”

Modified anterior cervical corpectomy fusion in the treatment of four-level cervical spondylotic myelopathy: a retrospective study with 5-year follow-up

“…The mean improvement rate was 58.8%(3 months after operation), 61.8%(6 months after operation), and 62.9%(the last follow-up);The average cervical lordosis changed from (9.19±3.11 mm before the operation to (12.79±4.15) mm 3 months after operation and (13.11±3. 19) mm at last follow-up; Postoperative complications including temporary hoarseness (2 patients), and C5 nerve root palsy (3patients), and improved after 2-week conservative treatments and had resolved completely at the 6-week follow up.…”

“…Cervical spondylotic myelopathy is a common disease in spinal surgery, accounting for 10% ~ 15% of all cervical spondylotic diseases. Due to compression of the spinal cord and subsequently emerged spinal cord compression symptoms, oppression content is derived from the degeneration of intervertebral disc, vertebral rear hyperplasia osteophyte, ossi cation of posterior longitudinal ligament, etc., 70% − 80% cervical spondylosis myelopathic have a characteristics of the progressive development, based on the pathophysiology of myelopathic type cervical vertebra disease characteristics, anterior approach could directly decompress ,relieve spinal cord compression, It is considered as the gold standard for surgical treatment of cervical spondylotic myelopathy [19]. For more than three levels of multilevel cervical spondylotic myelopathy, especially for four levels of cervical spondylotic myelopathy, the surgical method is still controversial [2,3,4,5,20,21,22,23].…”

Current Indications for Spinal Endoscopic Surgery and Potential for Future Expansion

“…Though ACDF has been the gold standard for cervical HIVD, arthroplasty with artificial disc replacement has rapidly risen in the recent decade. 49 The evidence supporting cervical arthroplasty has accumulated…”