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

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Clinical Orthopaedics and Related Research®

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.

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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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Authors and Affiliations

  1. Department of Orthopaedic Surgery, First Affiliated Hospital of Xi’an Jiaotong University, Room 1501, Inpatient Building, No. 277, Yantawest Road, Xi’an, China

    Si Yin MD, Shuangli Zhou MD, Zhanhai Yin PhD & Yusheng Qiu PhD

  2. Department of Neurosurgery, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China

    Xiao Yu MD

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  1. Si Yin MD
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Correspondence to Yusheng Qiu PhD.

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This work was performed at the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China.

Appendix 1. Complete search terms used in this study

Appendix 1. Complete search terms used in this study

PubMed: N = 136 (artificial disc replacement[mesh] OR artificial disc replace*[tw] OR total disc replacement[mesh] OR total disc replace*[tw] OR cervical disc replacement[mesh] OR cervical disc replace*[tw] OR cervical arthroplast*[tw] OR cervical prosthe*[tw] OR disc arthroplast*[tw] OR disc prosthe*[tw] OR artificial disc*[tw]) AND (arthrodesis[mesh] OR arthrodesis[tw] OR fusion[mesh] OR fusion[tw]) AND random*[tw] NOT (animals[mesh] NOT humans[mesh]).

EMBASE®: N = 198 (“artificial disc replacement”/syn OR [(“artificial disc” OR “total disc” OR “cervical disc”) NEAR/3 (replace* OR arthroplast*)]:ti,ab,de OR [cervical NEAR/3 prosthe*]:ti,ab,de OR [artificial NEAR/3 disc*]:ti,ab,de) AND (fusion/syn OR [fusion OR arthrodesis]:ti,ab,de) AND random*:ti,ab,de NOT (animal/de NOT human/de).

Cochrane: N = 169 (artificial disc replace* OR total disc replace* OR cervical disc replace* OR cervical arthroplast* OR cervical prosthe* OR disc arthroplast* OR artificial disc* OR disc prosthe*) AND (arthrodesis OR fusion) AND random* NOT (animal* NOT human*).

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Yin, S., Yu, X., Zhou, S. et al. Is Cervical Disc Arthroplasty Superior to Fusion for Treatment of Symptomatic Cervical Disc Disease? A Meta-Analysis. Clin Orthop Relat Res 471, 1904–1919 (2013). https://doi.org/10.1007/s11999-013-2830-0

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