Review ArticleThe change of adjacent segment after cervical disc arthroplasty compared with anterior cervical discectomy and fusion: a meta-analysis of randomized controlled trials
Introduction
Anterior cervical discectomy and fusion (ACDF) has been known as the “gold standard” for patients with cervical radiculopathy or myelopathy since described by Smith and Robinson more than a half century ago [1]. However, adjacent segment degeneration (ASDeg) and adjacent segment disease (ASDis) were paid more and more attention after long-term follow-up of ACDF [2]. Adjacent segment disease is different from ASDeg, which is defined as asymptomatic radiographic ASDeg [3]. Several papers have shown that ACDF accelerated the incidence of ASDeg through altering adjacent segment biomechanics [4], [5]. In a 60-month follow-up study, Zigler et al. [6] showed that the rate of ASDeg after ACDF in second-level patients was up to 54.7%, and adjacent segment reoperation was even as high as 11.6%.
Cervical disc arthroplasty (CDA) was introduced to reduce ASDeg, with the theory of maintaining intervertebral range of motion (ROM) and reducing compensatory ROM of adjacent segment. In many controlled trials, even a randomized controlled trial (RCT) showed that the incidence of ASD after CDA was lower than ACDF [5], [7], [8]; however, Hisey et al. [9] found that there was no statistically significant difference in the rate of ASDis between ACDF and CDA. Hence, some meta-analyses [10], [11], [12], [13] have tried to solve the controversy by reviewing RCTs. However, investigators are still unable to arrive at the same conclusion because of a lack of sufficient clinical RCTs, and the above meta-analyses focused only on the incidence of adjacent segment reoperation or ASDis. In our study, we searched RCTs exhaustively and performed a comprehensive meta-analysis to compare adjacent segment ROM, degeneration, disease, and reoperation between ACDF and CDA.
Section snippets
Materials and methods
We used the guidelines of the Cochrane Collaboration to perform the meta-analysis [14].
Search results
There were 2,471 relevant studies included according to the search strategy. First, 614 records remained after duplicates were removed; second, 533 titles were excluded after assessing the abstract and title; third, 29 articles were eligible for the inclusion criteria after review of the full text [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42] (Fig. 1). Reasons excluding articles by
Discussion
Since first reported in 1958 by Robinson et al., ACDF has been known as the gold standard in the treatment of cervical radiculopathy and myelopathy [1]. However, ASDeg and ASDis have become serious complications after ACDF in the long-term follow-up. The CDA was introduced to reduce the ASDeg through preserving the intervertebral ROM and theoretically reducing compensatory ROM and load of the adjacent segment. Nevertheless, there was controversy about the pathologic process of the adjacent
Conclusion
Our meta-analysis indicated that, compared with the ACDF group, the CDA group has the advantage of a lower ASDeg and fewer adjacent segment reoperations. However, there were no statistically significant differences in ASDis and adjacent segment ROM. More high-quality RCTs are needed to confirm the results and eliminate publication bias.
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[Translated article] Less superior adjacent syndrome and lower reoperation rate. Medium- and long-term results of cervical arthroplasty versus anterior cervical arthrodesis: Systematic review and meta-analysis of randomized clinical trials
2024, Revista Espanola de Cirugia Ortopedica y TraumatologiaSPECT/CT imaging for diagnosis and management of failed cervical spine surgery syndrome
2023, Interdisciplinary Neurosurgery: Advanced Techniques and Case ManagementCitation Excerpt :Although, 3 patients in our cohort reported no significant improvement from our interventions, patient demographics of high importance that might have influenced these unsuccessful treatment outcomes in these 3 patients included smoking history, steroid use, advanced disease, and advanced age [27-31]. Interestingly, 6 patients (26%) had documented adjacent segment disease due to the rigid fixation of the index level of prior fusion [32-35]. Since 2019 we incorporated SPECT/CT into our daily practice for patients with failed cervical fusion in part due to the significant diagnostic value of the present generation of SPECT/CT technology and believe it should be a part of the diagnostic armamentarium of every spine surgeon.
Less superior adjacent syndrome and lower reoperation rate. Medium- and long-term results of cervical arthroplasty versus anterior cervical arthrodesis: Systematic review and meta-analysis of randomized clinical trials
2023, Revista Espanola de Cirugia Ortopedica y Traumatologia
FDA device/drug status: Not applicable.
Author disclosures: LD: Grant: China Postdoctoral Science Foundation (A, Paid directly to institution/employer), pertaining to the submitted work. ZX: Grant: China Postdoctoral Science Foundation (A, Paid directly to institution/employer), pertaining to the submitted work. XC: Grant: China Postdoctoral Science Foundation (A, Paid directly to institution/employer), pertaining to the submitted work. DW: Grant: China Postdoctoral Science Foundation (A, Paid directly to institution/employer), pertaining to the submitted work. DL: Grant: China Postdoctoral Science Foundation (A, Paid directly to institution/employer), pertaining to the submitted work. TL: Grant: China Postdoctoral Science Foundation (A, Paid directly to institution/employer), pertaining to the submitted work. DH: Grant: China Postdoctoral Science Foundation (A, Paid directly to institution/employer), pertaining to the submitted work.
China Postdoctoral Science Foundation project funds (2016M602845) were received in support of this work. There are no other relevant financial activities outside the submitted work.
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