Document Detail


Is cervical disc arthroplasty superior to fusion for treatment of symptomatic cervical disc disease? A meta-analysis.
MedLine Citation:
PMID:  23389804     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 follow-ups 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 follow-ups 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.
Authors:
Si Yin; Xiao Yu; Shuangli Zhou; Zhanhai Yin; Yusheng Qiu
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Publication Detail:
Type:  Comparative Study; Journal Article; Meta-Analysis     Date:  2013-02-07
Journal Detail:
Title:  Clinical orthopaedics and related research     Volume:  471     ISSN:  1528-1132     ISO Abbreviation:  Clin. Orthop. Relat. Res.     Publication Date:  2013 Jun 
Date Detail:
Created Date:  2013-05-02     Completed Date:  2013-06-25     Revised Date:  2014-06-03    
Medline Journal Info:
Nlm Unique ID:  0075674     Medline TA:  Clin Orthop Relat Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1904-19     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Cervical Vertebrae / surgery
Decompression, Surgical / adverse effects,  methods*
Disability Evaluation
Diskectomy / adverse effects,  methods*
Female
Health Status
Humans
Intervertebral Disc Degeneration / surgery*
Male
Middle Aged
Neck / physiopathology
Pain Measurement
Postoperative Complications
Randomized Controlled Trials as Topic
Recovery of Function
Reoperation
Spinal Fusion / adverse effects,  methods*
Total Disc Replacement / adverse effects,  methods*
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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