The change of adjacent segment after cervical disc arthroplasty compared with anterior cervical discectomy and fusion: a meta-analysis of randomized controlled trials

Publication date: Available online 15 June 2017
Source:The Spine Journal
Author(s): Liang Dong, Zhengwei Xu, Xiujin Chen, Dongqi Wang, Dichen Li, Tuanjing Liu, Dingjun Hao
Backgroud ContextMany meta-analyses have been performed to study the efficacy of cervical disc arthroplasty (CDA) compared with anterior cervical discectomy and fusion (ACDF); however, there are few data referring to adjacent segment within these meta-analyses, or investigators are unable to arrive at the same conclusion in the few meta-analyses about adjacent segment. With the increased concerns surrounding adjacent segment degeneration (ASDeg) and adjacent segment disease (ASDis) after anterior cervical surgery, it is necessary to perform a comprehensive meta-analysis to analyze adjacent segment parameters.PurposeTo perform a comprehensive meta-analysis to elaborate adjacent segment motion, degeneration, disease, and reoperation of CDAcompared with ACDF.Study DesignMeta-analysis of randomized controlled trials (RCTs).Materials and MethodsPubmed, EMbase, and Cochrane Library were searched for RCTs comparing CDA and ACDF before May 2016. The analysis parameters included: follow-up time, operative segments, adjacent segment motion, ASDeg, ASDis and adjacent segment reoperation. The risk of bias scale was used to assess the papers. Subgroup analysis and sensitivity analysis were used to analyze the reason for high heterogeneity.ResultsTwenty-nine RCTs fulfilled the inclusion criteria. Compared with ACDF, the rate of adjacent segment reoperation in the CDA group was significantly lower (P < 0.01), and the advantage of that group in reducing adjacent segment reoperation increase with increasing of follow-up time by subgroup analysis. There was no statistically significant difference in ASDeg between CDA and ACDF within the 24-month follow-up period; however, the rate of ASDeg in CDA was significantly lower than that of ACDF with the increase in follow-up time (P < 0.01). There was no statistically significant difference in ASDis between CDA and ACDF (P > 0.05). CDA provided a lower adjacent segment range of motion (ROM) than did ACDF, but the difference was not statistically significant.ConclusionsCompared with ACDF, the advantages of CDA were lower ASDeg and adjacent segment reoperation. However, there was no statistically significant difference in ASDis and adjacent segment ROM.



http://ift.tt/2rzHeGu