Clinical Orthopaedics and Related Research®

, Volume 471, Issue 6, pp 1904–1919 | Cite as

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

  • Si Yin
  • Xiao Yu
  • Shuangli Zhou
  • Zhanhai Yin
  • Yusheng Qiu
Survey

Abstract

Background

As the current standard treatment for symptomatic cervical disc disease, anterior cervical decompression and fusion may result in progressive degeneration or disease of the adjacent segments. Cervical disc arthroplasty was theoretically designed to be an ideal substitute for fusion by preserving motion at the operative level and delaying adjacent level degeneration. However, it remains unclear whether arthroplasty achieves that aim.

Questions/purposes

We investigated whether cervical disc arthroplasty was associated with (1) better function (neck disability index, pain assessment, SF-36 mental and physical health surveys, neurologic status) than fusion, (2) a lower incidence of reoperation and major complications, and (3) a lower risk of subsequent adjacent segment degeneration.

Methods

We conducted a comprehensive search in MEDLINE®, EMBASE, and Cochrane Central Register of Controlled Trials and identified 503 papers. Of these, we identified 13 reports from 10 randomized controlled trials involving 2227 patients. We performed a meta-analysis of functional scores, rates of reoperation, and major complications. The strength of evidence was evaluated by using GRADE profiler software. Of the 10 trials, six trials including five prospective multicenter FDA-regulated studies were sponsored by industry. The mean followups of the 10 trials ranged from 1 to 5 years.

Results

Compared with anterior cervical decompression and fusion, cervical disc arthroplasty had better mean neck disability indexes (95% CI, −0.25 to −0.02), neurologic status (risk ratio [RR], 1.04; 95% CI, 1.00–1.08), with a reduced incidence of reoperation related to the index surgery (RR, 0.42; 95% CI, 0.22–0.79), and major surgical complications (RR, 0.45; 95% CI, 0.27–0.75) at a mean of 1 to 3 years. However, the operation rate at adjacent levels after two procedures was similar (95% CI, 0.31–1.27). The three studies with longer mean followups of 4 to 5 years also showed similar superiority of all four parameters of cervical disc arthroplasty compared with fusion.

Conclusions

For treating symptomatic cervical disc disease, cervical disc arthroplasty appears to provide better function, a lower incidence of reoperation related to index surgery at 1 to 5 years, and lower major complication rates compared with fusion. However, cervical disc arthroplasty did not reduce the reoperation rate attributable to adjacent segment degeneration than fusion. Further, it is unclear whether these differences in subsequent surgery including arthroplasty revisions will persist beyond 5 years.

Notes

Acknowledgments

We thank J. Kenneth Burkus MD at Spine Service, Wilderness Spine Services, the Hughston Clinic, for help in providing detailed clinical data of their trials.

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Copyright information

© The Association of Bone and Joint Surgeons® 2013

Authors and Affiliations

  • Si Yin
    • 1
  • Xiao Yu
    • 2
  • Shuangli Zhou
    • 1
  • Zhanhai Yin
    • 1
  • Yusheng Qiu
    • 1
  1. 1.Department of Orthopaedic SurgeryFirst Affiliated Hospital of Xi’an Jiaotong UniversityXi’anChina
  2. 2.Department of NeurosurgeryFirst Affiliated Hospital of Xi’an Jiaotong UniversityXi’anChina

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