Cervical disc arthroplasty versus fusion for single-level symptomatic cervical disc disease: A meta-analysis of randomized controlled trials

摘要

Objective: To evaluate the safety and effectiveness of cervical disc arthroplasty (CDA) versus anterior cervical discectomy and fusion (ACDF) for single-level symptomatic cervical disc disease. Methods: We identified eligible randomized controlled trials (RCTs) in PubMed (April 2011), EMBASE (April 2011) and Cochrane Central Register of Controlled Trials (April 2011). Data were collected and extracted by two reviewers independently. The methodological quality and clinical relevance of the included studies were assessed. Data analysis was conducted with RevMan 5.0. Results: Six RCTs involving 1,745 patients were included. The pooled analysis showed a higher prevalence of neurological and overall success [(P = 0.004, RR = 1.06, 95% CI = 1.02-1.10), (P = 0.0005, RR = 1.14, 95% CI = 1.06-1.22)], and a lower incidence of dysphagia and reoperation related to adjacent-segment degeneration [(P = 0.04, RR = 0.30, 95% CI = 0.09-0.97), (P = 0.03, RR = 0.46, 95% CI = 0.23-0.91)] with CDA compared to ACDF. However, there was no statistical difference in neck disability index (P = 0.92, SMD = 0.01, 95% CI = -0.25 to 0.27), neck and arm pain scores[(P = 0.33, SMD = -0.12, 95% CI = -0.37 to 0.13), (P = 0.54, SMD = 0.17, 95% CI = -0.36 to 0.70)], incidence of complications related to the implant or surgical procedure and reoperation related to primary surgery [(P = 0.32, RR = 0.76, 95% CI = 0.45-1.30), (P = 0.09, RR = 0.48, 95% CI = 0.20-1.12)]. Conclusion: Compared with ACDF, CDA carry a lower incidence of dysphagia complications and reoperation related to adjacent-segment degeneration, and a higher prevalence of neurological and overall success at 2 years postoperatively. As the poor quality of the included studies, it is still uncertain whether CDR is more effective and safer than ACDF treating single-level symptomatic cervical disc disease. Future large-scale RCTs with long-term follow-up are needed to provide clear evidence.