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Archives of Orthopaedic and Trauma Surgery

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01-02-2012 | Orthopaedic Surgery

Cervical disc arthroplasty versus fusion for single-level symptomatic cervical disc disease: a meta-analysis of randomized controlled trials

Authors: Hua Jiang, Zezhang Zhu, Yong Qiu, Bangping Qian, Xusheng Qiu, Mingliang Ji

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 2/2012

Abstract

Objective

To evaluate the safety and effectiveness of cervical disc arthroplasty (CDA) versus anterior cervical discectomy and fusion (ACDF) for single-level symptomatic cervical disc disease.

Methods

We identified eligible randomized controlled trials (RCTs) in PubMed (April 2011), EMBASE (April 2011) and Cochrane Central Register of Controlled Trials (April 2011). Data were collected and extracted by two reviewers independently. The methodological quality and clinical relevance of the included studies were assessed. Data analysis was conducted with RevMan 5.0.

Results

Six RCTs involving 1,745 patients were included. The pooled analysis showed a higher prevalence of neurological and overall success [(P = 0.004, RR = 1.06, 95% CI = 1.02–1.10), (P = 0.0005, RR = 1.14, 95% CI = 1.06–1.22)], and a lower incidence of dysphagia and reoperation related to adjacent-segment degeneration [(P = 0.04, RR = 0.30, 95% CI = 0.09–0.97), (P = 0.03, RR = 0.46, 95% CI = 0.23–0.91)] with CDA compared to ACDF. However, there was no statistical difference in neck disability index (P = 0.92, SMD = 0.01, 95% CI = −0.25 to 0.27), neck and arm pain scores[(P = 0.33, SMD = −0.12, 95% CI = −0.37 to 0.13), (P = 0.54, SMD = 0.17, 95% CI = −0.36 to 0.70)], incidence of complications related to the implant or surgical procedure and reoperation related to primary surgery [(P = 0.32, RR = 0.76, 95% CI = 0.45–1.30), (P = 0.09, RR = 0.48, 95% CI = 0.20–1.12)].

Conclusion

Compared with ACDF, CDA carry a lower incidence of dysphagia complications and reoperation related to adjacent-segment degeneration, and a higher prevalence of neurological and overall success at 2 years postoperatively. As the poor quality of the included studies, it is still uncertain whether CDR is more effective and safer than ACDF treating single-level symptomatic cervical disc disease. Future large-scale RCTs with long-term follow-up are needed to provide clear evidence.

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Title: Cervical disc arthroplasty versus fusion for single-level symptomatic cervical disc disease: a meta-analysis of randomized controlled trials
Authors: Hua Jiang
Zezhang Zhu
Yong Qiu
Bangping Qian
Xusheng Qiu
Mingliang Ji
Publication date: 01-02-2012
Publisher: Springer-Verlag
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 2/2012
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-011-1401-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Cervical disc arthroplasty versus fusion for single-level symptomatic cervical disc disease: a meta-analysis of randomized controlled trials

Abstract

Objective

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

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