Multilevel cervical disc replacement versus multilevel anterior discectomy and fusion

Abstract

Background:Cervical disc replacement (CDR) has been developed as an alternative surgical procedure to anterior cervical discectomy and fusion (ACDF) for the treatment of single-level cervical degenerative disc disease. However, patients with multilevel cervical degenerative disc disease (MCDDD) are common in our clinic. Multilevel CDR is less established compared with multilevel ACDF. This study aims to compare the outcomes and evaluate safety and efficacy of CDR versus ACDF for the treatment of MCDDD.Methods:A meta-analysis was performed for articles published up until August 2016. Randomized controlled trials (RCTs) and prospective comparative studies associated with the use of CDR versus ACDF for the treatment of MCDDD were included in the current study. Two reviewers independently screened the articles and data following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement.Results:Seven studies with 702 enrolled patients suffering from MCDDD were retrieved. Patients who underwent CDR had similar operative times, blood loss, Neck Disability Index (NDI) scores, and Visual Analog Scale (VAS) scores compared to patients who underwent ACDF. Patients who underwent CDR had greater overall motion of the cervical spine and the operated levels than patients who underwent ACDF. Patients who underwent CDR also had lower rates of adjacent segment degeneration (ASD). The rate of adverse events was significantly lower in the CDR group.Conclusion:CDR may be a safe and effective surgical strategy for the treatment of MCDDD. However, there is insufficient evidence to draw a strong conclusion due to relatively low-quality evidence. Future long-term, multicenter, randomized, and controlled studies are needed to validate the safety and efficacy of multilevel CDR.

Two-level cervical disc arthroplasty versus anterior cervical discectomy and fusion: 10-year outcomes of a prospective, randomized investigational device exemption clinical trial

“…Recent meta-analyses that compare CDA to ACDF are based on the large amount of published clinical trial data now available, although few focus specifically on two-level studies. 14,[34][35][36]38 One meta-analysis included 19 randomized controlled trials involving 4516 cases, the majority single level, with short-and midterm follow-up, and demonstrated better outcomes for CDA than ACDF on a wide variety of measures. 38 A number of other more recent meta-analyses have reported advantages to CDA.…”

One-Level Versus 2-Level Treatment With Cervical Disc Arthroplasty or Fusion: Outcomes Up to 7 Years

“…The negative effect of imperfect device positioning and endplate-device matching would likely be amplified in multilevel CDA. 19,20 The incidence of heterotopic ossification (HO) has been found to increase with the number of cervical arthroplasty levels without affecting patient-reported outcomes. 21,22 Further and stronger long-term evidence is still needed in order to evaluate multilevel cervical surgeries.…”

“…21,22 Further and stronger long-term evidence is still needed in order to evaluate multilevel cervical surgeries. 20,23 In an effort to establish the impact of increased surgical levels on the outcomes of both CDA and ACDF, a few studies have compared investigational and control arms within or across clinical trials so that 1-level CDA could be compared to 2-level CDA and 1-level ACDF compared to 2-level ACDF. [24][25][26] These studies indicated comparable outcomes for 1level and 2-level CDA but a decrease in efficacy from 1-level to 2-level ACDF.…”

Magnificamide is a new effective mammalian a-amylase inhibitor

“…Одной из разновидностей таких препаратов являются ингибиторы панкреатической α-амилазы, позволяющие эффективно контролировать поступление глюкозы в кровь из тонкого кишечника. Ингибирование слюнной α-амилазы также оказывает положительный эффект, так как позволяет затормозить переваривание крахмала на первых этапах его поступления в организм [5][6][7]. Однако используемое в настоящее время в качестве фармакологического препарата низкомолекулярное соединение акарбоза (Precose TM или Glucobay TM ) является слабым и малоселективным ингибитором панкреатической α-амилазы, и его применение сопровождается побочными эффектами [7].…”

“…Ингибирование слюнной α-амилазы также оказывает положительный эффект, так как позволяет затормозить переваривание крахмала на первых этапах его поступления в организм [5][6][7]. Однако используемое в настоящее время в качестве фармакологического препарата низкомолекулярное соединение акарбоза (Precose TM или Glucobay TM ) является слабым и малоселективным ингибитором панкреатической α-амилазы, и его применение сопровождается побочными эффектами [7]. Лекарственные препараты на основе белков и пептидов мало представлены на фармацевтическом рынке, однако интерес специалистов к таким соединениям возрастает вследствие их высокой селективности и эффективности в сочетании с относительной безопасностью и хорошей переносимостью [8].…”