A Meta-analysis Of Cervical Disc Arthroplasty Compared To Anterior Cervical Discectomy And Fusion For Degenerative Cervical Disc Disease

BackgroundThere is no consensus about which cervical disc arthroplasty or anterior cervicaldiscectomy and fusion is superior in the treatment of single-level cervical degenerativedisc disease. Mainly because the potential advantage of cervical disc arthroplasty overanterior cervical discectomy and fusion, that is, the prevention of adjacent segmentdegeneration in the long term, is not confirmed. So it is very important to know whetherresults of one of the two treatments are superior to the other in the short-term andmidterm follow-up.ObjectivesTo systematically compare and evaluate the outcomes of cervical disc arthroplastyand anterior cervical discectomy and fusion in the treatment of single-level degenerativecervical disc disease.MethodsThe references concerning cervical disc arthroplasty and anterior cervicaldiscectomy and fusion for the singel-level degenerative cervical disc disease wereretrieved through PubMed，Cochrane Library，Ovid，SpringerLink, the China Biological Medicine Database, Wafang Database and Weipu Database, as well as by manuallysearching the related journals and grey literature. The eligible trials were extractedaccording to the inclusion and exclusion criteria. The included trials were evaluated themethodological quality and strength of evidence. RevMan5.1software was used for dataanalysis.ResultsThe seven randomized controlled trials including nine reports involving2751patients were included in the final meta-analysis. The follow-up of the9reports rangedfrom1to5years.The short-term results of meta-analysis showed that there were no differencebetween two procedures in the PCS and MCS scores of SF-36(MD=0.98，95%CI：-0.33~-2.29, Z=1.46, P=0.14; MD=-0.85，95%CI：-2.49~0.79, Z=1.02, P=0.31), maincomplications （OR=0.82，95%CI:0.53～1.28,Z=0.88,P=0.38）, reoperation rate ofindex surgery（OR=-0.03,95%CI:-0.07～0.01, Z=1.68, P=0.07）, ROM of upper andlower adjacent levels (MD=0.11，95%CI：-0.53~0.75, Z=0.34, P=0.74; MD=-0.61，95%CI：-1.36~0.14, Z=1.59, P=0.11) and statistically difference in the operativetime(MD=21.60，95%CI：7.17~36.03, Z=2.93, P=0.003), blood loss(MD=16.31，95%CI：7.59~25.03, Z=3.67, P=0.0002), neck disability index（MD=-1.30，95%CI：-2.34~-0.26, Z=2.45, P=0.01), neck VAS（MD=-2.84，95%CI：-4.85~-0.84, Z=2.78,P=0.005), arm pain VAS MD=-1.84，95%CI：-3.07~-0.61, Z=2.92, P=0.003),reoperation rate of adjacent levels（OR=-0.02，95%CI:-0.04～0.00, Z=2.09, P=0.04）,ROM of index surgery ROM(MD=6.95，95%CI:6.74~7.17, Z=63.31, P＜0.00001).The midterm results of meta-analysis showed that there were no differencebetween two procedures in the reoperation rate of adjacent levels（OR=0.60，95%CI:0.33～1.10,Z=1.65,P=0.10）and statistically difference in the neck disability index(MD=-4.87，95%CI：-7.64~-2.11, Z=3.45, P=0.0006), reoperation rate indexsurgery （OR=0.41，95%CI:0.25～0.68,Z=3.45,P=0.0006）, the PCS scores ofSF-36(MD=2.76，95%CI：0.89~4.63, Z=2.89, P=0.004).ConclusionsIn the short-term follow-up, moderate-quality evidence showed anterior cervicaldiscectomy and fusion is superior to cervical disc arthroplasty in the aspect of operativetime and blood loss and cervical disc arthroplasty is superior to anterior cervicaldiscectomy and fusion in the aspect of neck disability index, arm pain VAS, reoperationrate of adjacent levels，low-quality evidence showed that cervical disc arthroplasty issuperior to anterior cervical discectomy and fusion in the aspect of neck VAS and ROMof index surgery, no evidence showed that which procedure has superiority in otheraspects. In the midterm-term follow-up, moderate-quality evidence showed that cervicaldisc arthroplasty is superior to anterior cervical discectomy and fusion in the aspect ofneck disability index, PCS scores of SF-36and reoperation rate of index surgery,low-quality evidence showed that two procedures are similar in the aspect ofreoperation rate of adjacent levels. According to this meta-analysis, the clinicaloutcomes of cervical arthroplasty are similar to or superior to the outcomes of anteriorcervical discectomy and fusion except for operative time and blood loss for thetreatment of single-level cervical diseases. However, this meta-analysis has severalmain limitations, so high-quality randomized controlled trials with long-term follow-upare needed to further assess these outcomes.