Document Detail


Cervical Arthroplasty: A Critical Review of the Literature.
MedLine Citation:
PMID:  24704679     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND CONTEXT: Cervical disc arthroplasty (CDA) is a motion preserving procedure that is an alternative to fusion. Proponents of arthroplasty assert it will maintain cervical motion and prevent or reduce adjacent segment degeneration. Accordingly, CDA, compared to fusion, would have the potential to improve clinical outcomes. Published studies have varying conclusions on whether CDA reduces complications and/or improves outcomes. As many of these previous studies have been funded by CDA manufacturers, we wanted to ascertain whether there was a greater likelihood for these studies to report positive results.
PURPOSE: To critically assess the available literature on cervical arthroplasty with a focus on time of publication and conflict of interest.
STUDY DESIGN/SETTING: Review of the literature.
METHODS: All clinical articles about CDA published in English through August 1st, 2013 were identified on Medline. Any paper that presented cervical disc arthroplasty clinical results was included. Study design, sample size, type of disc, length of follow-up, use of statistical analysis, quality of life (QOL) outcome scores, conflict of interest (COI), and complications were recorded. A meta-analysis was conducted stratifying studies by COI and publication date to identify differences in complication rates reported.
RESULTS: 74 studies were included that investigated 8 types of disc prosthesis; 22 met the criteria for a randomized controlled trial (RCT). All level Ib RCTs reported superior quality of life outcomes for CDA versus ACDF at 24 months. 50 of the 74 articles (68%) had a disclosure section, including all level Ib RCTs, which had significant COIs related to the respective studies. Those studies without a COI reported mean weighted average adjacent segment disease rates of 6.3% with CDA and 6.2% with ACDF. In contrast, the reverse was reported by studies with a COI, for which the averages were 2.5% with CDA and 6.3% with ACDF. Those studies with a COI (n=31) had an overall weighted average heterotopic ossification rate of 22% while those studies with no COI (n=43) had a rate of 46%.
CONCLUSIONS: Associated COIs did not influence QOL outcomes. COIs were more likely to be present in studies published after 2008, and those with a COI reported greater ASD rates for ACDF than CDA. In addition, HO rates were much lower in studies with COI versus those without COI. Thus, COIs did not impact QOL outcomes, but were associated with lower complication rates.
Authors:
Matthew D Alvin; E Emily Abbott; Daniel Lubelski; Benjamin Kuhns; Amy S Nowacki; Michael P Steinmetz; Edward C Benzel; Thomas E Mroz
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Publication Detail:
Type:  REVIEW     Date:  2014-4-3
Journal Detail:
Title:  The spine journal : official journal of the North American Spine Society     Volume:  -     ISSN:  1878-1632     ISO Abbreviation:  Spine J     Publication Date:  2014 Apr 
Date Detail:
Created Date:  2014-4-7     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101130732     Medline TA:  Spine J     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2014 Elsevier Inc. All rights reserved.
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