| Objective: The difference between cervical disc arthroplasty(CDA)and anterior cervical discectomy and fusion(ACDF),the "gold standard" treatment for degenerative cervical disc disease,has been controversial.With the rapid development and clinical application of cervical disc replacement,its short-term efficacy has been recognized by the industry,but its long-term effects need to be further evaluated.After collecting the literature,according to data from a randomized clinical trial of meta-analysis,this study compared the results of cervical disc arthroplasty and anterior cervical discectomy and fusion in the long-term follow-up of the surgical treatment of cervical disc degenerative diseases,in order to provide certain strong evidence for the clinical decision of surgical treatment of cervical spondylosis.Methods: The literatures published between Pubmed,EMBASE,Medline,Cochrane,CNKI,wanfang database,Chinese biomedical database and VIP database on the randomized clinical trial(relevant randomized controlled trial(RCT)of CDA and ACDF in the treatment of cervical disc degenerative diseases and the follow-up time was more than 5 years.The included randomized controlled studies were strictly evaluated for quality according to the Grade guidelines,and relevant data were extracted and summarized.Review Manager5.3 software was used to perform Meta analysis on six outcomes of patients’ life quality improvement(neck disability index(NDI)),surgical segment activity(ROM),neck arm VAS pain score,SF-36 score,surgical segment reoperation rate and adjacent surgical segment reoperation rate.Results: After rigorous retrieval and screening,a total of 10 randomized controlled clinical articles were included in the study.Long-term outcomes of surgical treatment were included in 1,476 patients whose last follow-up was more than 5 years.A meta-analysis of the data obtained shows that: the CDA group was superior to the ACDF group in improving the patients’ life quality improvement(neck disability index(NDI)),and the differences were statistically significant(SMD=-0.24,95%CI =-0.37 to-0.10,P=0.0005).There was no statistically significant difference between CDA group and the ACDF group in the operation segment mobility(ROM)(SMD=0.99,95%CI =-0.12-2.10,P= 0.08).There was no statistically significant difference between the neck and arm VAS pain score between the CDA group and the ACDF group in the neck arm VAS pain score(SMD=0.25,95%CI =-0.53-1.02,P=0.53).There was no significant difference in between CDA group and ACDF group in SF-36 score(SMD=0.97,95%CI =-0.44-2.39,P=0.18).The rate of surgical segment reoperation in CDA group was lower than that in ACDF group,and the difference was statistically significant(OR=0.36,95%CI =0.21-0.62,P=0.0002).The reoperation rate of adjacent surgical segments in the CDA group was also lower than that in the ACDF group,with statistically significant differences(OR=0.39,95%CI=0.23-0.66,P=0.0005).Conclusions: In summary,by comparing the long-term follow-up studies of CDA and ACDF at home and abroad in recent years,it was found that there were no significant statistical differences in the surgical segment mobility,the neck arm VAS pain score and SF-36 score in the long-term follow-up results of cervical disc replacement and traditional anterior cervical discectomy and fusion.In the meta-analysis of SF-36 score,due to the existence of heterogeneity due to the small number of samples,the results should be treated with caution.However,it can still be considered that both of them have the same effect in the treatment of cervical disc degenerative diseases.The differences in the index of neck dysfunction,the rate of surgical segment reoperation and the rate of adjacent surgical segment reoperation were statistically significant,indicating that cervical intervertebral disc replacement was relatively dominant,and the implicit benefits brought to the long-term quality of life of patients after discharge should not be underestimated.However,there is a certain bias in the conclusion,which needs to be further treated objectively.Only with more and larger samples,rigorous design,careful treatment,and high-quality randomized controlled trials,can we meet the requirements of evidence-based medicine and finally reach the correct conclusion. |
