Advertisement

Archives of Orthopaedic and Trauma Surgery

, Volume 135, Issue 1, pp 19–28 | Cite as

Cervical disc arthroplasty versus anterior cervical discectomy and fusion for treatment of symptomatic cervical disc disease: a meta-analysis of randomized controlled trials

  • Min-Jie Rao
  • Shao-Ping Nie
  • Bao-Wei Xiao
  • Gong-Heng Zhang
  • Xin-Rong Gan
  • Sheng-Sheng CaoEmail author
Orthopaedic Surgery

Abstract

Objective

The purpose of this study is to compare the effectiveness and safety of cervical disc arthroplasty with anterior cervical discectomy and fusion for treatment of symptomatic cervical disc disease.

Summary of background data

Anterior cervical discectomy and fusion (ACDF) is the conventional surgical treatment for symptomatic cervical disc disease. Recently, cervical disc arthroplasty (CDA) has been developed to address some of the shortcomings associated with ACDF by preserving function of the motion segment. Controversy still surrounds regarding whether CDA is better.

Methods

We systematically searched six electronic databases (Medline, Embase, Clinical, Ovid, BIOSIS and Cochrane registry of controlled clinical trials) to identify randomized controlled trials (RCTs) published up to April 2014 in which CDA was compared with ACDF for the treatment of symptomatic cervical disc disease. Effective data were extracted after the assessment of methodological quality of the trials. Then, we performed the meta-analysis.

Results

Eighteen relevant RCTs with a total of 4061 patients were included. The results of the meta-analysis indicated that CDA was superior to ACDF regarding better neurological success (P < 0.00001), greater motion preservation at the operated level (P < 0.00001), fewer secondary surgical procedures (P < 0.00001), and fewer rates of adverse events (P < 0.00001) but inferior to ACDF regarding operative times (P < 0.00001). No significant difference was identified between the two groups regarding blood loss (P = 0.87), lengths of hospital stay (P = 0.76), neck pain scores (P = 0.11) and arm pain scores (P = 0.78) reported on a visual analog scale.

Conclusion

The meta-analysis revealed that CDA demonstrated superiorities in better neurological success, greater motion preservation at the operated level, lower rate of adverse events and fewer secondary surgical procedures compared with ACDF. However, the benefits of blood loss, lengths of hospital stay, neck and arm pain functional recovery are still unable to be proved.

Keywords

Cervical disc arthroplasty Anterior cervical discectomy Meta-analysis Randomized controlled trial 

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Moon HJ, Kim JH, Kim JH et al (2011) The effects of anterior cervical discectomy and fusion with stand-alone cages at two contiguous levels on cervical alignment and outcomes. Acta Neurochir (Wien) 153(3):559–565CrossRefGoogle Scholar
  2. 2.
    Lied B, Roenning PA, Sundseth J et al (2010) Anterior cervical discectomy with fusion in patients with cervical disc degeneration: a prospective outcome study of 258 patients (181 fused with autologous bone graft and 77 fused with a PEEK cage). BMC Surg 10:10PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Xu R, Bydon M, Macki M et al (2014) Adjacent segment disease after anterior cervical discectomy and fusion: clinical outcomes after first repeat surgery versus second repeat surgery. Spine (Phila Pa 1976) 39(2):120–126CrossRefGoogle Scholar
  4. 4.
    Chung JY, Kim SK, Jung ST et al (2014) Clinical adjacent-segment pathology after anterior cervical discectomy and fusion: results after a minimum of 10-year follow-up. Spine J 14:2290–2298PubMedCrossRefGoogle Scholar
  5. 5.
    Li Z, Yu S, Zhao Y et al (2014) Clinical and radiologic comparison of dynamic cervical implant arthroplasty versus anterior cervical discectomy and fusion for the treatment of cervical degenerative disc disease. J Clin Neurosci 21:942–948PubMedCrossRefGoogle Scholar
  6. 6.
    Demetriades AK, Ringel F, Meyer B (2014) Cervical disc arthroplasty: a critical review and appraisal of the latest available evidence. Adv Tech Stand Neurosurg 41:107–129PubMedGoogle Scholar
  7. 7.
    Khong P, Bogduk N, Ghahreman A et al (2013) Cervical disc arthroplasty for the treatment of spondylotic myelopathy and radiculopathy. J Clin Neurosci 20(10):1411–1416PubMedCrossRefGoogle Scholar
  8. 8.
    Moatz B, Tortolani PJ (2012) Cervical disc arthroplasty: pros and cons. Surg Neurol Int 3(Suppl 3):S216–S224PubMedCentralPubMedGoogle Scholar
  9. 9.
    Yin S, Yu X, Zhou S et al (2013) Is cervical disc arthroplasty superior to fusion for treatment of symptomatic cervical disc disease? A meta-analysis. Clin Orthop Relat Res 471(6):1904–1919PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Xing D, Ma XL, Ma JX et al (2013) A meta-analysis of cervical arthroplasty compared to anterior cervical discectomy and fusion for single-level cervical disc disease. J Clin Neurosci 20(7):970–978PubMedCrossRefGoogle Scholar
  11. 11.
    Gao Y, Liu M, Li T et al (2013) A meta-analysis comparing the results of cervical disc arthroplasty with anterior cervical discectomy and fusion (ACDF) for the treatment of symptomatic cervical disc disease. J Bone Joint Surg Am 95(6):555–561PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Jiang H, Zhu Z, Qiu Y et al (2012) Cervical disc arthroplasty versus fusion for single-level symptomatic cervical disc disease: a meta-analysis of randomized controlled trials. Arch Orthop Trauma Surg 132(2):141–151PubMedCrossRefGoogle Scholar
  13. 13.
    Oremus M, Wolfson C, Perrault A et al (2001) Interrater reliability of the modified Jadad quality scale for systematic reviews of Alzheimer’s disease drug trials. Dement Geriatr Cogn Disord 12(3):232–236PubMedCrossRefGoogle Scholar
  14. 14.
    Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21(11):1539–1558PubMedCrossRefGoogle Scholar
  15. 15.
    Higgins JP, Thompson SG, Deeks JJ et al (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Zigler JE, Delamarter R, Murrey D et al (2013) ProDisc-C and anterior cervical discectomy and fusion as surgical treatment for single-level cervical symptomatic degenerative disc disease: five-year results of a Food and Drug Administration study. Spine (Phila Pa 1976) 38(3):203–209CrossRefGoogle Scholar
  17. 17.
    Phillips FM, Lee JY, Geisler FH et al (2013) A prospective, randomized, controlled clinical investigation comparing PCM cervical disc arthroplasty with anterior cervical discectomy and fusion. 2-year results from the US FDA IDE clinical trial. Spine Phila Pa (1976) 38(15):E907–E918CrossRefGoogle Scholar
  18. 18.
    Davis RJ, Kim KD, Hisey MS et al (2013) Cervical total disc replacement with the Mobi-C cervical artificial disc compared with anterior discectomy and fusion for treatment of 2-level symptomatic degenerative disc disease: a prospective, randomized, controlled multicenter clinical trial: clinical article. J Neurosurg Spine 19(5):532–545PubMedCrossRefGoogle Scholar
  19. 19.
    Coric D, Kim PK, Clemente JD et al (2013) Prospective randomized study of cervical arthroplasty and anterior cervical discectomy and fusion with long-term follow-up: results in 74 patients from a single site. J Neurosurg Spine 18(1):36–42PubMedCrossRefGoogle Scholar
  20. 20.
    Zhang X, Zhang X, Chen C et al (2012) Randomized, controlled, multicenter, clinical trial comparing BRYAN cervical disc arthroplasty with anterior cervical decompression and fusion in China. Spine (Phila Pa 1976) 37(6):433–438CrossRefGoogle Scholar
  21. 21.
    Murrey D, Janssen M, Delamarter R et al (2009) Results of the prospective, randomized, controlled multicenter Food and Drug Administration investigational device exemption study of the ProDisc-C total disc replacement versus anterior discectomy and fusion for the treatment of 1-level symptomatic cervical disc disease. Spine J 9(4):275–286PubMedCrossRefGoogle Scholar
  22. 22.
    Sasso RC, Smucker JD, Hacker RJ et al (2007) Clinical outcomes of BRYAN cervical disc arthroplasty: a prospective, randomized, controlled, multicenter trial with 24-month follow-up. J Spinal Disord Tech 20(7):481–491PubMedCrossRefGoogle Scholar
  23. 23.
    Steinmetz MP, Patel R, Traynelis V et al (2008) Cervical disc arthroplasty compared with fusion in a workers’ compensation population. Neurosurgery 63(4):741–747PubMedCrossRefGoogle Scholar
  24. 24.
    Wang Y, Cai B, Zhang XS et al (2008) Clinical outcomes of single level Bryan cervical disc arthroplasty: a prospective controlled study. Zhonghua Wai Ke Za Zhi 46(5):328–332PubMedGoogle Scholar
  25. 25.
    Burkus JK, Haid RW, Traynelis VC et al (2010) Long-term clinical and radiographic outcomes of cervical disc replacement with the Prestige disc: results from a prospective randomized controlled clinical trial. J Neurosurg Spine 13(3):308–318PubMedCrossRefGoogle Scholar
  26. 26.
    Heller JG, Sasso RC, Papadopoulos SM et al (2009) Comparison of BRYAN cervical disc arthroplasty with anterior cervical decompression and fusion: clinical and radiographic results of a randomized, controlled, clinical trial. Spine (Phila Pa 1976) 34(2):101–107CrossRefGoogle Scholar
  27. 27.
    Coric D, Cassis J, Carew JD et al (2010) Prospective study of cervical arthroplasty in 98 patients involved in 1 of 3 separate investigational device exemption studies from a single investigational site with a minimum 2-year follow-up. Clinical article. J Neurosurg Spine 13(6):715–721PubMedCrossRefGoogle Scholar
  28. 28.
    Mummaneni PV, Burkus JK, Haid RW et al (2007) Clinical and radiographic analysis of cervical disc arthroplasty compared with allograft fusion: a randomized controlled clinical trial. J Neurosurg Spine 6(3):198–209PubMedCrossRefGoogle Scholar
  29. 29.
    Cheng L, Nie L, Li M et al (2011) Superiority of the Bryan((R)) disc prosthesis for cervical myelopathy: a randomized study with 3-year follow up. Clin Orthop Relat Res 469(12):3408–3414PubMedCentralPubMedCrossRefGoogle Scholar
  30. 30.
    Coric D, Nunley PD, Guyer RD et al (2011) Prospective, randomized, multicenter study of cervical arthroplasty: 269 patients from the Kineflex|C artificial disc investigational device exemption study with a minimum 2-year follow-up: clinical article. J Neurosurg Spine 15(4):348–358PubMedCrossRefGoogle Scholar
  31. 31.
    Garrido BJ, Taha TA, Sasso RC (2010) Clinical outcomes of Bryan cervical disc arthroplasty a prospective, randomized, controlled, single site trial with 48-month follow-up. J Spinal Disord Tech 23(6):367–371PubMedCrossRefGoogle Scholar
  32. 32.
    Cheng L, Nie L, Zhang L et al (2009) Fusion versus Bryan Cervical Disc in two-level cervical disc disease: a prospective, randomised study. Int Orthop 33(5):1347–1351PubMedCentralPubMedCrossRefGoogle Scholar
  33. 33.
    Sasso RC, Anderson PA, Riew KD et al (2011) Results of cervical arthroplasty compared with anterior discectomy and fusion: four-year clinical outcomes in a prospective, randomized controlled trial. J Bone Joint Surg Am 93(18):1684–1692PubMedCrossRefGoogle Scholar
  34. 34.
    Brenke C, Dostal M, Carolus A et al (2014) Clinical relevance of neuroforaminal patency after anterior cervical discectomy and fusion. Acta Neurochir (Wien) 156:1197–1203CrossRefGoogle Scholar
  35. 35.
    Dagli M, Er U, Simsek S et al (2013) Late results of anterior cervical discectomy and fusion with interbody cages. Asian Spine J 7(1):34–38PubMedCentralPubMedCrossRefGoogle Scholar
  36. 36.
    Xu R, Bydon M, Macki M et al (2014) Adjacent segment disease after anterior cervical discectomy and fusion: clinical outcomes after first repeat surgery versus second repeat surgery. Spine Phila Pa (1976) 39(2):120–126CrossRefGoogle Scholar
  37. 37.
    Bydon M, Xu R, Macki M et al (2014) Adjacent segment disease after anterior cervical discectomy and fusion in a large series. Neurosurgery 74(2):139–146PubMedCrossRefGoogle Scholar
  38. 38.
    Hilibrand AS, Robbins M (2004) Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion? Spine J 4(6 Suppl):190S–194SPubMedCrossRefGoogle Scholar
  39. 39.
    Aghayev K, Doulgeris JJ, Gonzalez-Blohm SA et al (2014) Biomechanical comparison of a two-level anterior discectomy and a one-level corpectomy, combined with fusion and anterior plate reconstruction in the cervical spine. Clin Biomech (Bristol, Avon) 29(1):21–25CrossRefGoogle Scholar
  40. 40.
    Fay LY, Huang WC, Tsai TY et al (2014) Differences between arthroplasty and anterior cervical fusion in two-level cervical degenerative disc disease. Eur Spine J 23(3):627–634PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Min-Jie Rao
    • 1
  • Shao-Ping Nie
    • 1
  • Bao-Wei Xiao
    • 1
  • Gong-Heng Zhang
    • 1
  • Xin-Rong Gan
    • 1
  • Sheng-Sheng Cao
    • 1
    Email author
  1. 1.Department of OrthopedicsThe People’s Hospital of Yichun CityYichunPeople’s Republic of China

Personalised recommendations