Meta-analysis of artificial disc replacement versus anterior cervical discectomy and fusion in double-segment cervical disc disease

English Keywords:Total cervical disc replacement  Anterior cervical discectomy fusion  Two-level  Meta-analysis

English Abstract:

  【Abstract】 Objectives: To assess and compare the effectiveness and safety of total cervical disc replacement(TDR) and anterior cervical discectomy and fusion(ACDF) for double-segment cervical disc disease. Methods: The search was made in PubMed, Medline, Embase. The criterion of articles needed for system assessment should have included: (1)clinical control trails with application of two kinds of surgical treatment with double- segmental cervical spondylosis; (2)the treatment group received cervical disc replacement, while the control group received ACDF; (3)the number of patients must be more than 10 both in treatment group and control group; (4)the evaluation of postoperative effects must include visual analog scale(VAS) neck disability index(NDI) and the range of motion(ROM) of targeted levels etc. Doowns-Black score grade and NOS were applied to evaluate the quality of included studies. Results: There were 5 studies which included 593 patients(314 patients for Bryan cervical disc replacement, 279 patients for ACDF) in our system assessment. All articles were from English literature, among them 2 were random controlled trails while the rest were prospective cohort studies. The scores of Doowns-Black score system were 18 and above, the scores of NOS system were 6 stars and above. The meta-analysis showed that the standardized mean differences(SMD) of neck pain VAS score and relative risk(RR) of adverse events in the two groups were not significantly different(P>0.05); For the standardized mean differences(SMD) of upper limb pain VAS score, NDI score, ROM of flexion and extension of adjacent segment and relative risk(RR) of adjacent segment degeneration, those in TDR group were lower than those in ACDF group(P<0.05). SF36 PCS body health score and ROM of flexion and extension of operated segment in TDR group were higher than those in ACDF group(P<0.05). Conclusions: Our results indicate that total cervical disc replacement for double-segment cervical disc disease is safe and superior than ACDF in therapeutic effectiveness. But this needs more large sample randomized controlled trials and longer follow-up study.