Document Detail


A meta-analysis of comparative outcomes following cervical arthroplasty or anterior cervical fusion: results from 4 prospective multicenter randomized clinical trials and up to 1226 patients.
MedLine Citation:
PMID:  22037535     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY DESIGN: Meta-analysis of 4 prospective randomized controlled Food and Drug Administration (FDA) Investigational Device Exemption (IDE) clinical trials.
OBJECTIVE: To maximize the information available from 4 IDE studies by analyzing the combined outcomes of cervical arthroplasty versus fusion at 24-month follow-up.
SUMMARY OF BACKGROUND DATA: To date, 4 randomized clinical trials have been completed in the United States under FDA IDE protocols to study cervical arthroplasty. Each trial reported arthroplasty to be at least as successful as fusion controls based on noninferiority trial designs. However, sample sizes in any given trial may not be sufficient to demonstrate superiority of treatment effect. Meta-analysis enables pooling of results from comparable trials, which may lead to more precise and statistically significant estimates of treatment effect.
METHODS: Four cervical arthroplasty randomized clinical trials with comparable enrollment criteria and outcome measures were conducted independently by 3 separate sponsors to study the following devices: Bryan, Prestige, ProDisc-C, and PCM cervical disc replacements. A total of 1608 patients were treated across 98 investigative sites. Data were available for 1352 treated patients, of which 1226 were evaluable at 24 months. Assessments included clinical success definitions based on neck disability index, maintenance or improvement of neurological status, subsequent surgery or intervention at the index level (survivorship), and a composite score comprising these as well as serious device-related adverse events. Trial endpoint comparisons were made at 24 months postoperatively. For each endpoint, a random-effects meta-analysis was performed to compare the success rates of cervical arthroplasty with anterior cervical discectomy and fusion (ACDF). Also, supportive frequentist and bayesian analyses were performed.
RESULTS: The pooled primary overall success results indicated a statistically significant treatment effect favoring arthroplasty compared with ACDF. Overall success was achieved by 77.6% of the arthroplasty patients and by 70.8% of the ACDF patients (pooled odds ratio [OR]: 0.699, 95% confidence interval [CI]: 0.539-0.908, P = 0.007). The results of the individual subcomponent meta-analyses, all of which favored arthroplasty, were neck disability index success (OR: 0.786, 95% CI: 0.589-1.050, P = 0.103), neurological status (OR: 0.552, 95% CI: 0.364-0.835, P = 0.005), and survivorship (OR: 0.510, 95% CI: 0.275-0.946, P = 0.033). Only the survivorship endpoint suggested low heterogeneity.
CONCLUSION: These findings suggest that cervical arthroplasty is superior to ACDF in overall success, neurological success, and survivorship outcomes at 24 months postoperatively.
Authors:
Paul C McAfee; Chris Reah; Kye Gilder; Lukas Eisermann; Bryan Cunningham
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Publication Detail:
Type:  Comparative Study; Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Spine     Volume:  37     ISSN:  1528-1159     ISO Abbreviation:  Spine     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-05-11     Completed Date:  2012-09-07     Revised Date:  2012-10-24    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  943-52     Citation Subset:  IM    
Affiliation:
Spine and Scoliosis Center, St. Joseph's Hospital, Baltimore, MD, USA. mack8132@gmail.com
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MeSH Terms
Descriptor/Qualifier:
Arthroplasty / methods*
Cervical Vertebrae / surgery*
Humans
Multicenter Studies as Topic
Outcome Assessment (Health Care) / statistics & numerical data*
Randomized Controlled Trials as Topic
Spinal Fusion / methods*
Comments/Corrections
Comment In:
Spine (Phila Pa 1976). 2012 Sep 1;37(19):1720; author reply 1721-2   [PMID:  22735621 ]

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


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