European Spine Journal

, Volume 24, Issue 1, pp 101–112 | Cite as

Multi-level cervical disc arthroplasty (CDA) versus single-level CDA for the treatment of cervical disc diseases: a meta-analysis

  • Hua Zhao
  • Lei Cheng
  • Yong Hou
  • Yi Liu
  • Ben Liu
  • Jyoti Joshi Mundra
  • Lin NieEmail author
Original Article



Cervical disc arthroplasty (CDA) was developed to treat cervical degenerated disc diseases with the advantages of preserving the kinematics of the functional spinal unit. However, the safety and reliability of multi-level CDA are still controverted when comparing to the single-level CDA. It has shown unclear benefits in terms of clinical results, functional recovery, heterotopic ossification, and the need for secondary surgical procedures. The purpose of this study is to estimate the effectiveness of multi-level cervical arthroplasty over single-level CDA for the treatment of cervical spondylosis and disc diseases.


To compare the studies of multi-level CDA versus single-level CDA in patients with cervical spondylosis that reported at least one of the following outcomes: functionality, neck pain, arm pain, quality of life, reoperation and incidence of heterotopic ossification, electronic databases (Medline, Embase, Pubmed, Cochrane library, and Cochrane Central Register of Controlled Trials) were searched. No language restrictions were used. Two authors independently assessed the methodological quality of included studies and extracted the relevant data.


Out of Eight cohorts that were included in the study, four were prospective cohorts and the other four were retrospective. The results of the meta-analysis indicated that there was no significant difference in neck disability index scores, neck visual analog scale (VAS), arm VAS, morbidity of reoperation, heterotopic ossification, and parameters of living quality when comparing multi-level CDA with single-level CDA at 1 and 2 years follow-up postoperatively (p > 0.05).


The meta-analysis revealed that the outcomes and functional recovery of patients performed with multi-level CDA are equivalent to those with single-level CDA, which suggests the multi-level CDA is as effective and safe as single-level invention for the treatment of cervical spondylosis. Nonetheless, more well-designed studies with large groups of patients are needed to provide further evidence for the benefit and reliability of multi-level CDA in the treatment of cervical disc diseases.


Cervical disc arthroplasty Multi-level Single-level Cervical disc diseases Meta-analysis 



This work was supported by the grant from Ph.D. Programs Foundation of Ministry of Education of China (20110131120079) and Shandong Provincial Natural Science Foundation, China (No. ZR2013HM095).


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Hua Zhao
    • 1
  • Lei Cheng
    • 1
  • Yong Hou
    • 1
  • Yi Liu
    • 1
  • Ben Liu
    • 1
  • Jyoti Joshi Mundra
    • 2
  • Lin Nie
    • 1
    Email author
  1. 1.Department of Spine SurgeryQilu Hospital of Shandong UniversityJinanChina
  2. 2.Department of Orthopaedic SurgeryNew York University Medical CenterNew YorkUSA

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