Comparison Of Total Disc Replacement Versus Fusion For Lumbar Degenerative Disc Disease: A Meta-analysis

Background:Lumbar fusion has been developed for several decades as the gold standard for treatment ofsymptomatic lumbar degenerative disc disease(LDDD). However, but it has the drawbacks ofincreasing stress on the adjacent segments, which may cause new instability and pain. Artificialtotal disc replacement (TDR) as an alternative to spinal fusion has been postulated that the patient’snormal intervertebral segment motion might be restored and maintained, but there is still acontroversy whether TDR is more effective and safer than lumbar fusion.Objective:Systematically compare the efficacy and safety of TDR to fusion for the treatment of LDDD.Method:All published randomized controlled trials comparing TDR with lumbar fusion intervention forLDDD were searched for by two authors independently,We searched databases including PubMed、EMBASE、OVID、Cochrane Library、CNKI，and a manual search of Chinese Journals was alsoperformed to identify additional studies. After the methodology of the included studies wereevaluated and heterogeneity analysis,the data were extracted from included studies independentlyby two reviewers and RevMan software (vesion5.3) was used for data analysis.Result:Five relevant RCTs with a total of1,506patients were included. There were no significantdifferences between the two treatment methods regarding operating time (MD=﹣44.12，95%CI[﹣94.73，﹣6.49]，P=0.09), blood loss (MD=﹣29.41，95%CI[-173.84,115.01]，P=0.69), Narcotic Medication Use （OR=0.61，95%CI[0.35，1.06]，P=0.08）， Work Status (OR=1.08，95%CI[0.84，1.38]，P=0.56), and the reoperation rate (OR=0.76，95%CI[0.50，1.13]，P=0.18). TDR was moreeffective in ODI (MD=﹣5.36，95%CI[-7.90，﹣2.82]， P＜0.0001),VAS score (MD=﹣5.65,95%CI[-9.11，﹣2.19]，P=0.001), complications （OR=0.41，95%CI[0.29，0.57]，P＜0.0001)，rate of satisfaction（OR=2.08，95%CI[1.54，2.81]，P＜0.00001)，shorter duration of hospitalization(MD=﹣0.82,95%CI[-1.38,﹣0.26] P=0.004)， a greater proportion of willing to choose thesame operation again (OR=2.12，95%CI[1.64，2.75]，P＜0.00001).Conclusion:TDR showed significant safety and efficacy comparable to lumbar fusion at2year follow-up,but more high-quality RCTs are still needed to certify the result in long—term follow up.