Effectiveness Of Cervical Disc Replacement Versus Anterior Cervical Decompression And Fusion For Single Level Cervical Spondylosis: A Systematic Review

OBJECTIVE To evaluate the efficacy and safety of cervical disc replacement versus ACDF for single level cervical spondylosis.DATA SOURCES PubMed, Embase, the Cochrane library of clinical control trials, Chinese Biomedical Literature Database(CBM), CNKI, VIP databases and reference lists of all relevant articles were retrieved with end time of April 2009.DATA SELECTION Inclusion criteria:①Randomized controlled trial.②Cervical syndrome patients, whom was confirmed caused by single level degenerative disc disease using computerized tomography ormagnetic resonance imaging, and was ineffective to the expectant treatment. Exclusion criteria:Patients with the following situation:①Severe osteoporosis.②Systemic metabolic disease.③Trauma.④Infection.⑤Tumor.⑥Operated segments were instable.⑦Metal sensitivity.⑧Abnormal cervical vertebrae.⑨Severe cervical spinal stenosis or multi-segmental cervical spondylosis.⑩Received cervical vertebra surgery or severe organic disease. According to inclusion and exclusion criteria, studies were screened and the data was extracted independently by two reviewers, and the risk of bias and data analysis in these studies was evaluated by Cochrane Handbook 5.0.0.MAIN OUTCOME MEASURES Two reviewers extracted the data independently with a uniform table, which comprises demography data, motion range of cervical part, total successful ratio of surgery, score index of abnormal cervical part, pain score of upper limb, mean operation duration, blood loss, hospitalization time, secondery operation, adverse effect and complications.RESULTS Seven randomized controlled trials including 1400 patients were included. To some extent, risk of selectivity bias, performance bias, measurement bias and other biases existed in all studies. Those 7 randomized controlled trial mostly did not provide sufficiently original data and had discrepancy. Four studies showed that cervical disc replacement was better than ACDF. Two studies proved that cervical disc replacement had obtained a better herapeutic effect than ACDF at the early clinical application, and proposed to extend the follow-up. Only one study indicated that cervical disc replacement was similar to ACDF in therapeutic effect.CONCLUSIONS Cervical disc replacement has superior curative effect to ACDF at the recent phase of clinical application. However, all studies included never reported the related data of long-term follow up, therefore, this systematic review can not draw definite conclusion that whether cervical disc replacement can prevent adjacent segment degeneration.