Meta-analysis on anterior cervical artificial disc replacement versus anterior cervical decompression and fusion for bi-level cervical spondylosis

English Keywords:Anterior cervical artificial disc replacement  Anterior cervical decompression and fusion  Bi-level cervical spondylosis  Follow-up  Meta-analysis

English Abstract:

  【Abstract】 Objectives: To systematically assess the clinical effectiveness and safety of anterior cervical artificial disc replacement(ACDR) versus anterior cervical decompression and fusion(ACDF) for bi-level cervical spondylosis. Methods: According to the computer-based online search of PubMed, Embase, Medline, Cochrane Library, CBM, CNKI, Wanfang Database and VIP, the articles published before May lst, 2016 were searched. Articles designed for randomized controlled trials(RCT) and cohort study about ACDR compared with ACDF for bi-level cervical spondylosis, RCT and cohort studies were included. The quality score of methodology was assessed by Jadad and MINORS. Two authors independently assessed trial quality and extracted data． Data of neck disability index(NDI) score, VAS neck and arm pain, SF-36 score, neurological success, adjacent-segment degeneration, subsequent surgical intervention, adverse events, patient satisfaction at 24mo, 48mo, 60mo after operation from those studies were abstracted and synthesized by Review Manager 5.3 for Meta-analysis. Reasults: 7 RCT and 2 cohort studies with a total of 2570 patients were included(1601 in the ACDR group and 969 in the ACDF group, with 24mo, 48mo, 60mo follow-up). The methodological quality score of 7 RCT studies included in the Meta-analysis was from 3 to 4, 2 cohort studies was 18. Compared with ACDF, ACDR had batter NDI[SMD=0.52; 95%CI: (0.43, 0.62), P<0.00001], VAS neck[SMD=0.19; 95%CI: (0.10, 0.29), P<0.0001], VAS arm[SMD=0.15; 95%CI: (0.06, 0.25), P=0.002], SF-36 physical component summary scores(PCS)[SMD=0.35; 95%CI: (0.25, 0.44), P<0.00001]. Meta-analysis indicated that no differences were found in the rate of neurologic success[RR=1.01; 95%CI: (0.97, 1.05), P=0.54]. The ACDR of superior levels adjacent-segment degeneration [RR=0.43; 95%CI: (0.37, 0.51), P<0.00001], inferior levels adjacent-segment degeneration[RR=0.35; 95%CI: (0.19, 0.66), P=0.001], subsequent surgical intervention[RR=0.30; 95%CI: (0.23, 0.40), P<0.00001], adverse events[RR=0.72; 95%CI: (0.58, 0.89), P=0.003], patient satisfaction[RR=1.08; 95%CI: (1.04, 1.11), P<0.0001] had lower incident rate compared with ACDF at 24mo, 48mo, 60mo. Conclusions: for bi-level cervical spondylosis, ACDR was consistent with ACDF in improvement of neurologic success, however, in improvement of quality of life, reduction of the operative complications, the former is superior to the latter.