Literature ReviewRate of Adjacent Segment Degeneration of Cervical Disc Arthroplasty Versus Fusion Meta-Analysis of Randomized Controlled Trials
Introduction
Anterior cervical discectomy and fusion (ACDF) has been considered a gold standard for symptomatic cervical degenerative disc disease (DDD)1, 2, 3; however, there is evidence showing that this procedure usually results in the loss of motion at the operated level4, 5 and accelerated adjacent level disc degeneration.6 A previous long-term follow-up study reported that the incidence of adjacent segment disease (ASD) after ACDF was up to 54.7%, and adjacent segment reoperation was even as high as 11.6%.7
Cervical disc arthroplasty (CDA) is an alternative to fusion after anterior neural decompression.8 CDA offers the theoretical advantage of preservation of the motion patterns and the range of motion (ROM), reconstitution of disc height and spinal alignment, and earlier recovery of cervical function.9, 10 However, many controlled trials reported controversial results with the incidence of ASD after CDA.11, 12, 13, 14, 15, 16, 17, 18
Previous meta-analyses have compared the rate of ASD between CDA and ACDF19, 20, 21, 22, 23; however, there is still no consensus concerning the superiority of CDA or ACDF regarding the incidence of ASD. To further clarify controversies in the current literature, we performed a meta-analysis to evaluate the incidence of ASD between CDA and ACDF.
Section snippets
Search Strategy and Study Selection
Electronic searches were performed using Cochrane Library, PubMed, and Embase from their dates of inception to November 2017. No language was restricted. The following search terms were used: “anterior cervical decompression and fusion”, “cervical arthrodesis”, “disc replacement”, “disc prostheses”, and “cervical arthroplasty” and “clinical trial” as either keywords or MeSH terms. Reference lists of all included studies were scanned to identify additional potentially relevant studies.
Data Extraction
Two reviewers independently extracted the data using a standardized form, which covered the following items: study design, first author, publication date, mean age, sample size, length of follow-up, rate of ASD, adjacent segment reoperation, preoperative and postoperative C2–C7 ROM, and prosthesis type.
Results
The process of identifying relevant studies is summarized in Figure 1. From the selected databases, 9993 references were obtained, of which 1859 remained after excluding duplicates. After screening the titles and abstracts, 1767 trials were excluded because they did not reach the standard of inclusion criteria. The retaining 92 potential articles were retrieved for further full-text evaluation. Finally, 21 RCTs were included in our meta-analysis.11, 12, 13, 14, 15, 25, 26, 27, 28, 29, 30, 31, 32
Discussion
ACDF is an effective and safe procedure for the surgical treatment of patients with cervical DDD. However, ACDF increases the stress on adjacent segments, which can accelerate disc degeneration and lead to ASDs.41, 42, 43 In addition, multilevel fusion will cause a compensatory increase of the motion at the adjacent levels, which will cause ASD consequently in long-term follow-up.44 Recently, a long-term prospective cohort study concluded that secondary surgeries were performed for
Conclusion
In conclusion, our meta-analysis reveals CDA had significantly fewer ASD and adjacent segment reoperations compared with the ACDF. CDA is superior to ACDF in ASD. This suggests CDA is an effective alternative invention for the treatment of cervical DDD to preserve cervical range of motion and reduce the risk of ASD. However, this requires further validation and investigation in larger sample-size prospective and randomized studies with long-term follow-up.
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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 TraumatologiaLess 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 TraumatologiaAnterior Cervical Discectomy and Fusion Versus Cervical Disc Arthroplasty: A Comparison of National Trends and Outcomes
2022, World NeurosurgeryCitation Excerpt :This modality of surgery provides an avenue for decompression of the spinal cord and nerve roots while allowing for restoration of the disc height and cervical alignment.21 However, the fusion component of the procedure, both through instrumentation as well as subsequent bony growth within the construct, lends to loss of mobility within the fused segments.22,23 The biomechanical force distribution resulting from the loss of mobility within the fused joint spaces increases stress on adjacent disc spaces and results in adjacent-segment disease (ASD).24,25
Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Jiaquan Luo, Hongbo Wang and Jun Peng equally contributed to this work.