Liang Dong1, Zhengwei Xu1, Xiujin Chen1, Dongqi Wang1, Dichen Li2, Tuanjing Liu1, Dingjun Hao3. 1. Department of Spine Surgery, Hong-Hui Hospital, Xi' an Jiaotong University College of Medicine, No 555, YouYi East road, Xi'an 710054, China. 2. School of Mechanical Engineering, Xi' an Jiaotong University, No 28, XianNing West road, Xi'an 710054, China. 3. Department of Spine Surgery, Hong-Hui Hospital, Xi' an Jiaotong University College of Medicine, No 555, YouYi East road, Xi'an 710054, China. Electronic address: dingjunhaospine@163.com.
Abstract
BACKGROUND CONTEXT: Many meta-analyses have been performed to study the efficacy of cervical disc arthroplasty (CDA) compared with anterior cervical discectomy and fusion (ACDF); however, there are few data referring to adjacent segment within these meta-analyses, or investigators are unable to arrive at the same conclusion in the few meta-analyses about adjacent segment. With the increased concerns surrounding adjacent segment degeneration (ASDeg) and adjacent segment disease (ASDis) after anterior cervical surgery, it is necessary to perform a comprehensive meta-analysis to analyze adjacent segment parameters. PURPOSE: To perform a comprehensive meta-analysis to elaborate adjacent segment motion, degeneration, disease, and reoperation of CDA compared with ACDF. STUDY DESIGN: Meta-analysis of randomized controlled trials (RCTs). METHODS: PubMed, Embase, and Cochrane Library were searched for RCTs comparing CDA and ACDF before May 2016. The analysis parameters included follow-up time, operative segments, adjacent segment motion, ASDeg, ASDis, and adjacent segment reoperation. The risk of bias scale was used to assess the papers. Subgroup analysis and sensitivity analysis were used to analyze the reason for high heterogeneity. RESULTS: Twenty-nine RCTs fulfilled the inclusion criteria. Compared with ACDF, the rate of adjacent segment reoperation in the CDA group was significantly lower (p<.01), and the advantage of that group in reducing adjacent segment reoperation increases with increasing follow-up time by subgroup analysis. There was no statistically significant difference in ASDeg between CDA and ACDF within the 24-month follow-up period; however, the rate of ASDeg in CDA was significantly lower than that of ACDF with the increase in follow-up time (p<.01). There was no statistically significant difference in ASDis between CDA and ACDF (p>.05). Cervical disc arthroplasty provided a lower adjacent segment range of motion (ROM) than did ACDF, but the difference was not statistically significant. CONCLUSIONS: Compared with ACDF, the advantages of CDA were lower ASDeg and adjacent segment reoperation. However, there was no statistically significant difference in ASDis and adjacent segment ROM.
BACKGROUND CONTEXT: Many meta-analyses have been performed to study the efficacy of cervical disc arthroplasty (CDA) compared with anterior cervical discectomy and fusion (ACDF); however, there are few data referring to adjacent segment within these meta-analyses, or investigators are unable to arrive at the same conclusion in the few meta-analyses about adjacent segment. With the increased concerns surrounding adjacent segment degeneration (ASDeg) and adjacent segment disease (ASDis) after anterior cervical surgery, it is necessary to perform a comprehensive meta-analysis to analyze adjacent segment parameters. PURPOSE: To perform a comprehensive meta-analysis to elaborate adjacent segment motion, degeneration, disease, and reoperation of CDA compared with ACDF. STUDY DESIGN: Meta-analysis of randomized controlled trials (RCTs). METHODS: PubMed, Embase, and Cochrane Library were searched for RCTs comparing CDA and ACDF before May 2016. The analysis parameters included follow-up time, operative segments, adjacent segment motion, ASDeg, ASDis, and adjacent segment reoperation. The risk of bias scale was used to assess the papers. Subgroup analysis and sensitivity analysis were used to analyze the reason for high heterogeneity. RESULTS: Twenty-nine RCTs fulfilled the inclusion criteria. Compared with ACDF, the rate of adjacent segment reoperation in the CDA group was significantly lower (p<.01), and the advantage of that group in reducing adjacent segment reoperation increases with increasing follow-up time by subgroup analysis. There was no statistically significant difference in ASDeg between CDA and ACDF within the 24-month follow-up period; however, the rate of ASDeg in CDA was significantly lower than that of ACDF with the increase in follow-up time (p<.01). There was no statistically significant difference in ASDis between CDA and ACDF (p>.05). Cervical disc arthroplasty provided a lower adjacent segment range of motion (ROM) than did ACDF, but the difference was not statistically significant. CONCLUSIONS: Compared with ACDF, the advantages of CDA were lower ASDeg and adjacent segment reoperation. However, there was no statistically significant difference in ASDis and adjacent segment ROM.
Authors: Julian L Gendreau; Lily H Kim; Payton N Prins; Marissa D'Souza; Paymon Rezaii; Arjun V Pendharkar; Eric S Sussman; Allen L Ho; Atman M Desai Journal: Global Spine J Date: 2019-11-21
Authors: Nicolas Lonjon; Emmanuel Favreul; Jean Huppert; Eric Lioret; Manuel Delhaye; Ramzi Mraidi Journal: Medicine (Baltimore) Date: 2019-01 Impact factor: 1.817
Authors: Anna Kotkansalo; Antti Malmivaara; Merja Korajoki; Katariina Korhonen; Ville Leinonen Journal: Acta Neurochir (Wien) Date: 2019-08-10 Impact factor: 2.216