The change of adjacent segment after cervical disc arthroplasty compared with anterior cervical discectomy and fusion: a meta-analysis of randomized controlled trials

Li, Dong; Zhou, Xu; Chen, Xiujin; Wang, Dongqi; Li, Dichen; Liu, Tuanjing; Hao, Dingjun

doi:10.1016/j.spinee.2017.06.010

Cited by 56 publications

(38 citation statements)

References 45 publications

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“…The biomechanical advantages have been well established 3,49 . A recent metaanalysis showed that there was no statistically significant difference in ASD between CDA and ACDF within 24-months' follow-up period, but ASD was significantly lower with an increase of follow-up duration in CDA 16 . In contrast, Xu et al 21 and Zhu et al 23 found that CDA was superior in reducing the ASD incident rate when compared with ACDF, and this superiority became more apparent over time 21 .…”

Section: Discussionmentioning

confidence: 98%

“…The biomechanical advantages have been well established. A recent meta‐analysis showed that there was no statistically significant difference in ASD between CDA and ACDF within 24‐months’ follow‐up period, but ASD was significantly lower with an increase of follow‐up duration in CDA. In contrast, Xu et al .…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, there have been several metaanalyses comparing CDA with ACDF. Most of them have included partial long-term results, but they were mixed up with short-term and mid-term results 5,[16][17][18][19][20][21][22][23] . Therefore, given the availability of newly published long-term results [28][29][30][31][32][33][34][35][36][37][38] , we performed this study.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, Xu et al 21 and Zhu et al 23 found that CDA was superior in reducing the ASD incident rate when compared with ACDF, and this superiority became more apparent over time 21 . Although these 3 studies 16,21,23 attempted to evaluate ASD and symptomatic ASD separately, the follow-up period was not separated clearly, and long-term results were weak. Our results show that CDA has significantly lower symptomatic ASD.…”

Section: Discussionmentioning

confidence: 99%

“…In the past 20 years, a series of randomized controlled trials (RCT) have been conducted; however, the reported results are inconsistent and have great variability. Although a few systematic reviews have been performed, researchers have failed to reach an agreement owing to varied criteria 5,[16][17][18][19][20][21][22][23][24] . Nevertheless, there is an absence of pooling of long-term results in a comprehensive meta-analysis.…”

Section: Introductionmentioning

confidence: 99%

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Long‐term Results Comparing Cervical Disc Arthroplasty to Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

Wang

et al. 2019

Orthopaedic Surgery

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Objective Whether cervical disc arthroplasty (CDA) is superior to anterior cervical discectomy and fusion (ACDF) remains controversial, especially in relation to long‐term results. The present study aimed to evaluate the long‐term safety and efficiency of CDA and ACDF for cervical disc disease. Methods We performed this study according to the Cochrane methodology. An extensive search was undertaken in PubMed, Embase, and Cochrane databases up to 1 June 2019 using the following key words: “anterior cervical fusion,” “arthroplasty,” “replacement” and “artificial disc”. RevMan 5.3 (Cochrane, London, UK) was used to analyze data. Safety and efficiency outcome measures included the success rate, functional outcome measures, adverse events (AE), adjacent segment degeneration (ASD), secondary surgery, and patients’ satisfaction and recommendation rates. The OR and MD with 95% confidence interval (CI) were used to evaluate discontinuous and continuous variables, respectively. The statistically significant level was set at P < 0.05. Results A total of 11 randomized controlled trials with 3505 patients (CDA/ACDF: 1913/1592) were included in this meta‐analysis. Compared with ACDF, CDA achieved significantly higher overall success (2.10, 95% CI [1.70, 2.59]), neck disability index (NDI) success (1.73, 95% CI [1.37, 2.18]), neurological success (1.65, 95% CI [1.24, 2.20]), patients’ satisfaction (2.14, 95% CI [1.50, 3.05]), and patients’ recommendation rates (3.23, 95% CI [1.79, 5.80]). Functional outcome measures such as visual analog score neck pain (−5.50, 95% CI [−8.49, −2.52]) and arm pain (−3.78, 95% CI [−7.04, −0.53]), the Short Form‐36 physical component score (SF‐36 PCS) (1.93, 95% CI [0.53, 3.32]), and the Short Form‐36 mental component score (SF‐36 MCS) (2.62, 95% CI [0.95, 4.29]), revealed superiority in the CDA group. CDA also achieved a significantly lower rate of symptomatic ASD (0.46, 95% CI [0.34, 0.63]), total secondary surgery (0.50, 95% CI [0.29, 0.87]), secondary surgery at the index level (0.46, 95% CI [0.29, 0.74]), and secondary surgery at the adjacent level (0.37, 95% CI [0.28, 0.49]). However, no significant difference was found in radiological success (1.35, 95% CI [0.88, 2.08]), NDI score (−2.88, 95% CI [−5.93, 0.17]), total reported AE (1.14, 95% CI [0.92, 1.42]), serious AE (0.89, 95% CI [0.71, 1.11]), device/surgery‐related AE (0.90, 95% CI [0.68, 1.18]), radiological superior ASD (0.63, 95% CI [0.28, 1.43]), inferior ASD (0.45, 95% CI [0.19, 1.11]), and work status (1.33, 95% CI [0.78, 2.25]). Furthermore, subgroup analysis showed different results between US and non‐US groups. Conclusion Our study provided further evidence that compared to ACDF, CDA had a higher long‐term clinical success rate and better functional outcome measurements, and resulted in less symptomatic ASD and fewer secondary surgeries. However, worldwide multicenter RCT with long‐term follow up are still needed for further evaluation in the future.

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