Comparison of artificial total disc replacement versus fusion for lumbar degenerative disc disease: a meta-analysis of randomized controlled trials

Abstract

PurposeTo compare the efficacy and safety of TDR to that of the fusion for the treatment of lumbar degenerative disc disease (LDDD).MethodsRandomized controlled trials comparing TDR with any other intervention for LDDD were acquired by a comprehensive search in PubMedCentral, MEDLINE, EMBASE, BIOSIS, ClinicalTrials.gov, and the FDA trials register. Methodologic quality was assessed and relevant data were retrieved, and appropriate meta-analysis was performed. Two review authors independently selected studies, extracted data, and assessed risk of bias. Results and upper bounds of confidence intervals were compared with predefined clinically relevant differences.ResultsSix relevant randomized controlled trials (RCTs) involving 1,603 patients were identified and reported two year follow-up results. Patients in TDR group compared with lumbar fusion group demonstrated significant improvements in ODI, VAS scores and complication rates at the two year follow-up. Meanwhile, except for operating time in anterior group, intra-operative blood loss, operating time in posterior group, and reoperation rate were without clinical significance between the two groups. In addition, the range of motion (ROM) was maintained within normal ranges after TDR.ConclusionsThe results showed the TDR has significant safety and efficacy comparable to lumbar fusion at two year follow-up. Although superiority compared to fusion could not be proved, by comparing clinical symptoms relieved, motion preserved, and the low reoperation rate during long-term follow-up on TDR, TDR was considered safe and effective. Therefore, the authors suggest adopting TDR on a large scale; with failure of TDR, interbody fusion would be performed.

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].…”

An 11-year minimum follow-up of the Charite III lumbar disc replacement for the treatment of symptomatic degenerative disc disease

“…Reoperations at the index level are required in 0-28.6 % of cases [31,[43][44][45]. Siepe et al [45] categorized the reoperation rates into those resulting from general surgeryrelated complications, those for implant-or device-related complications, and those that were required for the treatment of adjacent-level pathologies.…”

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.…”