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



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.

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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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Corresponding author

Correspondence to Lin Nie.

Additional information

H. Zhao and L. Cheng contributed equally to this study.

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Zhao, H., Cheng, L., Hou, Y. et al. Multi-level cervical disc arthroplasty (CDA) versus single-level CDA for the treatment of cervical disc diseases: a meta-analysis. Eur Spine J 24, 101–112 (2015).

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