Abstract
Background
Anterior cervical discectomy and fusion (ACDF) has been considered as a gold standard for symptomatic cervical disc degeneration (CDD), which may result in progressive degeneration of the adjacent segments. The artificial cervical disc was designed to reduce the number of lesions in the adjacent segments. Clinical studies have demonstrated equivalence of cervical disc arthroplasty (CDA) for anterior cervical discectomy and fusion in single segment cervical disc degeneration. But for two contiguous levels cervical disc degeneration (CDD), which kind of treatment method is better is controversial.
Purpose
To evaluate the clinical effects requiring surgical intervention between anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) at two contiguous levels cervical disc degeneration.
Methods
We conducted a comprehensive search in multiple databases, including PubMed, Cochrane Central Register of Controlled Trials, EBSCO and EMBASE. We identified that six reports meet inclusion criteria. Two independent reviewers performed the data extraction from archives. Data analysis was conducted with RevMan 5.3.
Results
After applying inclusion and exclusion criteria, six papers were included in meta-analyses. The overall sample size at baseline was 650 patients (317 in the TDR group and 333 in the ACDF group). The results of the meta-analysis indicated that the CDA patients had significant superiorities in mean blood loss (P < 0.00001, standard mean differences (SMD) = −0.85, 95 % confidence interval (CI) = −1.22 to −0.48); reoperation (P = 0.0009, risk ratio (RR) = 0.28, 95 % confidence interval (CI) = 0.13–0.59), adjacent segment degeneration (P < 0.00001, risk ratio (RR) = 0.48, 95 % confidence interval (CI) = 0.40–0.58) and Neck Disability Index (P = 0.002, SMD = 0.31, 95 % CI = 0.12–0.50). No significant difference was identified between the two groups regarding mean surgical time (P = 0.84, SMD = −0.04, 95 % CI = −0.40 to 0.32), neck and arm pain scores (P = 0.52, SMD = 0.06, 95 % CI = −0.13 to 0.25) reported on a visual analog scale and rate of postoperative complications [risk ratio (RR) = 0.79; 95 % CI = 0.50–1.25; P = 0.31]. The CDA group of sagittal range of motion (ROM) of the operated and adjacent levels, functional segment units (FSU) and C2-7 is superior to ACDF group by radiographic data of peroperation, postoperation and follow-up.
Conclusion
We can learn from this meta-analysis that the cervical disc arthroplasty (CDA) group is equivalent and in some aspects has more significant clinical outcomes than the ACDF group at two contiguous levels CDD.
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References
Goffin J, Geusens E, Vantomme N et al (2004) Long-term follow-up after interbody fusion of the cervical spine. J Spinal Disord Tech 17:79–85
Smith GW, Robinson RA (1958) The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am Vol 40:607–624
Fraser JF, Härtl R (2007) Anterior approaches to fusion of the cervical spine: a metaanalysis of fusion rates. J Neurosurg Spine 6:298–303
Cloward RB (1958) The anterior approach for removal of ruptured cervical disks. J Neurosurg 15:602–617
DiAngelo DJ, Foley KT, Vossel KA et al (2000) Anterior cervical plating reverses load transfer through multilevel strut-grafts. Spine 25:783–795
Yang YC, Nie L, Cheng L et al (2009) Clinical and radiographic reports following cervical arthroplasty: a 24-month follow-up. Int Orthop 33:1037–1042
Buchowski JM, Anderson PA, Sekhon L et al (2009) Cervical disc arthroplasty compared with arthrodesis for the treatment of myelopathy. Surgical technique. J Bone Joint Surg Am Vol 91(Suppl 2):223–232
Goffin J, Van Calenbergh F, van Loon J et al (2003) Intermediate follow-up after treatment of degenerative disc disease with the Bryan cervical disc prosthesis: single-level and bi-level. Spine 28:2673–2678
Wigfield C, Gill S, Nelson R et al (2002) Influence of an artificial cervical joint compared with fusion on adjacent-level motion in the treatment of degenerative cervical disc disease. J Neurosurg 96:17–21
Heller JG, Sasso RC, Papadopoulos SM et al (2009) Comparison of BRYAN cervical disc arthroplasty with anterior cervical decompression and fusion: clinical and radiographic results of a randomized, controlled, clinical trial. Spine (Philadelphia, 1976) 34:101–107
Luo J, Gong M, Huang S et al (2015) Incidence of adjacent segment degeneration in cervical disc arthroplasty versus anterior cervical decompression and fusion meta-analysis of prospective studies. Arch Orthop Trauma Surg 135:155–160. doi:10.1007/s00402-014-2125-2
Neuman Brian J (2014) Cervical disc arthroplasty: a selective alternative to fusion. Semin Spine Surg 26:160–166. doi:10.1053/j.semss.2014.08.007
Davis RJ, Nunley PD, Kim KD et al (2015) Two-level total disc replacement with Mobi-C cervical artificial disc versus anterior discectomy and fusion: a prospective, randomized, controlled multicenter clinical trial with 4-year follow-up results. J Neurosurg Spine 22:15–25. doi:10.3171/2014.7.spine13953
Hou Y, Liu Y, Yuan W et al (2014) Cervical kinematics and radiological changes after discover artificial disc replacement versus fusion. Spine J: Off J N Am Spine Soc 14:867–877. doi:10.1016/j.spinee.2013.07.432
Cheng L, Nie L, Li M et al (2011) Superiority of the Bryan((R)) disc prosthesis for cervical myelopathy: a randomized study with 3-year followup. Clin Orthop Relat Res 469:3408–3414. doi:10.1007/s11999-011-2039-z
Jawahar A, Cavanaugh DA, Kerr EJ 3rd et al (2010) Total disc arthroplasty does not affect the incidence of adjacent segment degeneration in cervical spine: results of 93 patients in three prospective randomized clinical trials. Spine J: Off J N Am Spine Soc 10:1043–1048. doi:10.1016/j.spinee.2010.08.014
Grob D, Porchet F, Kleinstuck FS et al (2010) A comparison of outcomes of cervical disc arthroplasty and fusion in everyday clinical practice: surgical and methodological aspects. Eur Spine J: Off Public Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cervical Spine Res Soc 19:297–306. doi:10.1007/s00586-009-1194-3
Kim SW, Limson MA, Kim SB et al (2009) Comparison of radiographic changes after ACDF versus Bryan disc arthroplasty in single and bi-level cases. Eur Spine J: Off Public Eur Spine Soc Eur Spinal Deform So Eur Sect Cervical Spine Res Soc 18:218–231. doi:10.1007/s00586-008-0854-z
Dmitriev AE, Cunningham BW, Hu N et al (2005) Adjacent level intradiscal pressure and segmental kinematics following a cervical total disc arthroplasty: an in vitro human cadaveric model. Spine 30:1165–1172
Hilibrand AS, Carlson GD, Palumbo MA et al (1999) Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am 81:519–528
Fuller DA, Kirkpatrick JS, Emery SE et al (1998) A kinematic study of the cervical spine before and after segmental arthrodesis. Spine 23:1649–1656
Sasso RC, Best NM, Metcalf NH et al (2008) Motion analysis of Bryan cervical disc arthroplasty versus anterior discectomy and fusion: results from a prospective, randomized, multicenter, clinical trial. J Spinal Disord Tech 21:393–399
Park DK, Lin EL, Phillips FM (2010) Index and adjacent level kinematics after cervical disc replacement and anterior fusion: in vivo quantitative radiographic analysis. Spine (Philadelphia, 1976) 36:721–730
Phillips FM, Tzermiadianos MN, Voronov LI et al (2009) Effect of two-level total disc replacement on cervical spine kinematics. Spine 34:E794–E799. doi:10.1097/BRS.0b013e3181afe4bb
Watanabe S, Inoue N, Yamaguchi T et al (2012) Three-dimensional kinematic analysis of the cervical spine after anterior cervical decompression and fusion at an adjacent level: a preliminary report. Eur Spine J: Off Public Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 21:946–955. doi:10.1007/s00586-011-2090-1
Verma Kushagra, Gandhi Sapan D, Maltenfort Mitchell et al (2013) Rate of adjacent segment disease in cervical disc arthroplasty versus single-level fusion. Spine 38:2253–2257. doi:10.1097/brs.0000000000000052
Dalury DF, Jiranek WA (2004) The incidence of heterotopic ossification after total knee arthroplasty. J Arthroplasty 19:447–452
Rama KR, Vendittoli PA, Ganapathi M et al (2009) Heterotopic ossification after surface replacement arthroplasty and total hip arthroplasty: a randomized study. J Arthroplasty 24:256–262. doi:10.1016/j.arth.2007.12.004
Huppert J, Beaurain J, Steib JP et al (2011) Comparison between single- and multi-level patients: clinical and radiological outcomes 2 years after cervical disc replacement. Eur Spine J: Off Public Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 20:1417–1426. doi:10.1007/s00586-011-1722-9
Quan GM, Vital JM, Hansen S et al (2011) Eight-year clinical and radiological follow-up of the Bryan cervical disc arthroplasty. Spine 36:639–646. doi:10.1097/BRS.0b013e3181dc9b51
McAfee PC, Cappuccino A, Cunningham BW et al (2010) Lower incidence of dysphagia with cervical arthroplasty compared with ACDF in a prospective randomized clinical trial. J Spinal Disord Tech 23:1–8. doi:10.1097/BSD.0b013e31819e2ab8
Aragones M, Hevia E, Barrios C (2015) Polyurethane on titanium unconstrained disc arthroplasty versus anterior discectomy and fusion for the treatment of cervical disc disease: a review of level I-II randomized clinical trials including clinical outcomes. Eur Spine J 24:2735–2745. doi:10.1007/s00586-015-4228-z
Skeppholm M, Lindgren L, Henriques T et al (2015) The discover artificial disc replacement versus fusion in cervical radiculopathy—a randomized controlled outcome trial with 2-year follow-up. Spine J: Off J N Am Spine Soc 15:1284–1294. doi:10.1016/j.spinee.2015.02.039
Mummaneni PV, Amin BY, Wu JC et al (2012) Cervical artificial disc replacement versus fusion in the cervical spine: a systematic review comparing long-term follow-up results from two FDA trials. Evid-Based Spine-Care J 3:59–66. doi:10.1055/s-0031-1298610
Nandyala SV, Marquez-Lara A, Fineberg SJ et al (2014) Comparison of revision surgeries for one- to two-level cervical TDR and ACDF from 2002 to 2011. Spine J: Off J N Am Spine Soc 14:2841–2846. doi:10.1016/j.spinee.2014.03.037
Anderson PA, Sasso RC, Riew KD (2008) Comparison of adverse events between the Bryan artificial cervical disc and anterior cervical arthrodesis. Spine 33:1305–1312. doi:10.1097/BRS.0b013e31817329a1
Gao Y, Liu M, Li T et al (2013) A meta-analysis comparing the results of cervical disc arthroplasty with anterior cervical discectomy and fusion (ACDF) for the treatment of symptomatic cervical disc disease. J Bone Joint Surg-Am 95A:555–561. doi:10.2106/jbjs.k.00599
Delamarter RB, Zigler J (2013) Five-year reoperation rates, cervical total disc replacement versus fusion, results of a prospective randomized clinical trial. Spine 38:711–717. doi:10.1097/BRS.0b013e3182797592
Pickett GE, Sekhon LH, Sears WR et al (2006) Complications with cervical arthroplasty. J Neurosurg Spine 4:98–105. doi:10.3171/spi.2006.4.2.98
Eck JC, Humphreys SC, Lim TH et al (2002) Biomechanical study on the effect of cervical spine fusion on adjacent-level intradiscal pressure and segmental motion. Spine 27:2431–2434. doi:10.1097/01.brs.0000031261.66972.b1
Anderson PA, Sasso RC, Hipp J et al (2012) Kinematics of the cervical adjacent segments after disc arthroplasty compared with anterior discectomy and fusion: a systematic review and meta-analysis. Spine 37:S85–S95. doi:10.1097/BRS.0b013e31826d6628
Laxer EB, Darden BV, Murrey DB et al (2006) Adjacent segment disc pressures following two-level cervical disc replacement versus simulated anterior cervical fusion. Stud Health Technol Inform 123:488–492
Ishihara H, Kanamori M, Kawaguchi Y et al (2004) Adjacent segment disease after anterior cervical interbody fusion. Spine J: Off J N Am Spine Soc 4:624–628. doi:10.1016/j.spinee.2004.04.011
Lund T, Oxland TR (2011) Adjacent level disk disease—is it really a fusion disease? Orthop Clin N Am 42:529–541. doi:10.1016/j.ocl.2011.07.006 (viii)
Rosenthal P, Kim KD (2013) Cervical adjacent segment pathology following fusion: is it due to fusion? World J Orthop 4:112–113. doi:10.5312/wjo.v4.i3.112
Coric D, Nunley PD, Guyer RD et al (2011) Prospective, randomized, multicenter study of cervical arthroplasty: 269 patients from the Kineflex|C artificial disc investigational device exemption study with a minimum 2-year follow-up: clinical article. J Neurosurg Spine 15:348–358. doi:10.3171/2011.5.spine10769
Smith HE, Wimberley DW, Vaccaro AR (2004) Cervical arthroplasty: material properties. Neurosurg Focus 17:E3
Chen J, Wang X, Bai W et al (2012) Prevalence of heterotopic ossification after cervical total disc arthroplasty: a meta-analysis. Eur Spine J: Off Public Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 21:674–680. doi:10.1007/s00586-011-2094-x
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There was no fund to support this study. We thank all the anonymous reviewers for their helpful suggestions to improve the quality of our paper.
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Zou, S., Gao, J., Xu, B. et al. Anterior cervical discectomy and fusion (ACDF) versus cervical disc arthroplasty (CDA) for two contiguous levels cervical disc degenerative disease: a meta-analysis of randomized controlled trials. Eur Spine J 26, 985–997 (2017). https://doi.org/10.1007/s00586-016-4655-5
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DOI: https://doi.org/10.1007/s00586-016-4655-5