Systematic Review and Meta-analysis of Randomized Controlled Trials: Comparison of Total Disk Replacement With Anterior Cervical Decompression and Fusion

Abstract

The authors performed a systematic review and meta-analysis to evaluate whether there is a beneficial clinical effect of total disk replacement compared with anterior cervical diskectomy and fusion for the treatment of single-level symptomatic cervical disk disease. A comprehensive literature search of multiple databases, including PubMed (1966-2011), Cochrane Controlled Trials Register (CENTRAL; issue 1, 2011), and Embase (1984-2011), was conducted to identify studies that met the inclusion criteria. Methodologic quality was assessed and relevant data were retrieved, and if appropriate, meta-analysis was performed. Eight randomized controlled trials were identified; six of the 8 reported 24-month follow-up results. At 24 months, total disk replacement was demonstrated to be more beneficial for patients compared with anterior cervical diskectomy and fusion for the following outcomes: overall success rate (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.37-2.33; P<.0001), overall reoperation rate (OR,.36; CI, .21-.61; P=0), reoperation rate for revision (OR, .12; CI, .02 to .64; P=.01), and visual analog scale neck pain scores (standard mean differences [SMD], -.48; CI, -.91 to -.05; P=.03). Other outcomes, including Neck Disability Index scores (SMD, -.02; CI, -.44 to .27; P=.67) and visual analog scale arm pain scores (SMD, -.21; CI, -.63 to .22; P=.34), demonstrated no differences between the 2 groups. For patients with single-level symptomatic cervical disk disease, total disk replacement was found to be more effective than anterior cervical diskectomy and fusion in the 2 outcomes of overall success rate and overall reoperation rate at 24 months. Long-term results also showed total disk replacement trended to be more effective than anterior cervical diskectomy and fusion in some aspects.

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

“…Four systematic reviews have consistently shown a higher rate of neurological success in the ACDA group compared to the ACDF group [35][36][37][38]. This finding is also supported by our study.…”

“…This finding is also supported by our study. Most meta-analyses reported no statistical or clinically significant difference between the two groups in NDI and arm or neck pain [36,38,39]. However, one recently published systematic review [40] reported an improvement for both the NDI and arm or neck pain in the ACDA group which differs from the results of other meta-analyses [36,38,39].…”

Is Cervical Disc Arthroplasty Superior to Fusion for Treatment of Symptomatic Cervical Disc Disease? A Meta-Analysis

“…M-H = Mantel-Haenszel method; ACDF = cervical decompression and fusion; CDA = cervical disc arthroplasty. [4,21,45,47] because it assesses the updated and full range of relevant RCTs with no or fewer restrictions related to the followup periods, number of surgical segments, and languages. Furthermore, we assessed the strength of evidence by using the GRADE approach and provide a current synthesis of the state of the evidence on cervical disc arthroplasty and anterior cervical decompression and fusion.…”

Five-Year Results of Cervical Disc Prostheses in the SWISSspine Registry

“…A systematic review and meta-analysis of RCTs by Yu et al [28] reported an overall reoperation rate of 2.8 % for cervical TDA and 7.5 % for anterior discectomy and fusion at 2-year follow-up, which was significantly different. Different prospective randomized single-level studies comparing cervical TDA to anterior discectomy and fusion reported variable revision rates between 1.8 and 11 % [8,13,[29][30][31].…”