| ObjectiveAnterior cervical discectomy and fusion(ACDF) has long been regarded as the treatment of cervical spondylosis of nerve root type and myelopathic type was the standard operation for cervical spondylosis, but it is always associate with some complications, such as pseudarthrosis, function of adjacent intervertebral disc degeneration, swallowing difficulties, etc., and the adjacent segment degeneration problem is one of the most common. Cervical total disc replacement(CTDR) is regarded as a new substitute for ACDF surgery, which can maintain segmental motion mode of operation. But heterotopic ossification and influence on ASD caused by CTDR remains controversial in clinical, so whether CTDR is superior to the ACDF is not yet clear and unified.A Meta-analysis, contrast the treatment curative effect of CTDR and ACDF for single segmental degenerative cervical spondylosis, and evaluation of two kinds of operative methods on the clinical efficacy of whether existed differences, in order to help clinical doctors in the treatment of single segmental degenerative cervical spondylopathy of operation and choice to provide basis.MethodsUsing computer to search the databases from January 2000 to January 2015, including PUBMED, EMBASE, the Cochrane Library, MEDLINE, Chinese biomedical medicine database (CBM), CNKI, China science and technology journal database, Chinese Wanfang database, to find the randomized controlled trials (randomized controlled trials, RCT) research literature of CTDR and ACDF comparison for the treatment of aged 18 to 65 patients with single segmental degenerative cervical spondylopathy. And choose the Cochrane collaboration for a randomized controlled trial of risk of bias to evaluate the quality of the literatures. Using STATA 11.0 statistical software for Meta-analysis.ResultsFinally eight studies included in the standard,a total of 2426 patients, including CTDR group 1258 examples, ACDF group 1168 cases. Meta-analysis results show that:1. Postoperative neck disability index (NDI) no statistically significant differences between the two groups WMD=-2.31, 95%CI=-5.04-0.43, P=0.098; 2. The postoperative NDI success of CTDR group is superior to ACDF group RR=1.08,95%CI=1.03-1.14, P=0.004; 3. The arm pain visual analog scale score (arm VAS) for the differences between the two groups have no statistical significance WMD=-0.09,95%CI=-1.45-1.27, P=0.896; 4. Postoperative neck pain visual analog scale score (neck VAS) for the differences between the two groups has no statistical significance WMD=5.41, 95%CI=-1.67-12.48, P=0.134; 5. Postoperative SF-36 scale score CTDR group is superior to the ACDF WMD=2.15,95%CI=0.29-4.01, P=0.024; 6. There was statistical significance in ROM for the differences between the two groups. CTDR group is superior to the ACDF WMD=6.46,95%CI=3.42-9.50, P<0.001; 7. Postoperative radiological success for the differences between the two groups has no statistical significance RR=1.03,95%CI=0.91-1.15, P=0.668; 8. After reoperation rate for the differences between the two groups have no statistical significance RR=0.77,95%CI=0.53-1.11, P=0.159.ConclusionThe use of surgical treatment of single segmental degenerative cervical spondylosis (including nerve root type and myelopathic type),whose basic principle is through the decompression of nerve and spinal cord, is to build a good environment for nerve function recovery. From the perspective of the data analysis of research, in terms of postoperative functional recovery and quality of life improved, CTDR group is obviously better than the ACDF group. From middle-term observation, in terms of keeping cervical range of motion and reducing the risk of reoperation, CTDR group were not significantly better than ACDF group. May be limited by the quality of the literature, different kinds of bias, limited sample size, and limited follow-up time, we need more high quality, large sample randomized controlled trial to make more reliable conclusions. |
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