Cervical disc arthroplasty versus anterior cervical discectomy and fusion for treatment of symptomatic cervical disc disease: a meta-analysis of randomized controlled trials
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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.
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.
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.
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.
KeywordsCervical disc arthroplasty Anterior cervical discectomy Meta-analysis Randomized controlled trial
Conflict of interest
The authors declare that they have no conflict of interest.
- 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
- 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.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.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
- 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
- 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
- 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