Abstract
BackgroundMeta-analyses on the comparison between fusion and prosthesis in the treatment of cervical radiculopathy mainly analyse studies including mixed patient populations: patients with radiculopathy with and without myelopathy. The outcome for patients with myelopathy is different compared to those without. Furthermore, apart from decompression of the spinal cord, restriction of motion is one of the cornerstones of the surgical treatment of spondylotic myelopathy. From this point of view, the results for arthroplasty might be suboptimal for this category of patients. Comparing clinical outcome in patients exclusively suffering from radiculopathy is therefore a more valid method to compare the true clinical effect of the prosthesis to that of fusion surgery.AimThe objective of this study was to compare clinical outcome of cervical arthroplasty (ACDA) to the clinical outcome of fusion (ACDF) after anterior cervical discectomy in patients exclusively suffering from radiculopathy, and to evaluate differences with mixed patient populations.MethodsA literature search was completed in PubMed, EMBASE, Web of Science, COCHRANE, CENTRAL and CINAHL using a sensitive search strategy. Studies were selected by predefined selection criteria (i.a.) patients exclusively suffering from cervical radiculopathy), and risk of bias was assessed using a validated Cochrane Checklist adjusted for this purpose. An additional overview of results was added from articles considering a mix of patients suffering from myelopathy with or without radiculopathy.ResultsEight studies were included that exclusively compared intervertebral devices in radiculopathy patients. Additionally, 29 articles concerning patients with myelopathy with or without radiculopathy were studied in a separate results table. All articles showed intermediate to high risk of bias. There was neither a difference in decrease in mean NDI score between the prosthesis (20.6 points) and the fusion (20.3 points) group, nor was there a clinically important difference in neck pain (VAS). Comparing these data to the mixed population data demonstrated comparable mean values, except for the 2-year follow-up NDI values in the prosthesis group: mixed group patients that received a prosthesis reported a mean NDI score of 15.6, indicating better clinical outcome than the radiculopathy patients that received a prosthesis though not reaching clinical importance.ConclusionsACDF and ACDA are comparably effective in treating cervical radiculopathy due to a herniated disc in radiculopathy patients. Comparing the 8 radiculopathy with the 29 mixed population studies demonstrated that no clinically relevant differences were present in clinical outcome between the two types of patients.Graphic abstractThese slides can be retrieved under Electronic Supplementary Material.
Highlights
Anterior cervical discectomy with fusion (ACDF) is considered the standard surgical treatment for cervical radiculopathy
It appeared that the meta-analyses considered mainly randomized controlled trials (RCTs) that were performed on mixed patient populations: patients suffering from primarily radiculopathy and patients suffering from primarily myelopathy
Meticulous literature research reveals that pain and disability scores were comparable in patients after 2 years and not dependent on receiving either a cage or a prosthesis, after anterior cervical discectomy for radiculopathy
Summary
Anterior cervical discectomy with fusion (ACDF) is considered the standard surgical treatment for cervical radiculopathy. An overview of Bartels et al (2017) considered 21 meta-analyses in which the included studies tended to conclude that ACDA gave a better outcome, but differences were small and not clinically relevant [6]. It appeared that the meta-analyses considered mainly randomized controlled trials (RCTs) that were performed on mixed patient populations: patients suffering from primarily radiculopathy and patients suffering from primarily myelopathy. Aim The objective of this study was to compare clinical outcome of cervical arthroplasty (ACDA) to the clinical outcome of fusion (ACDF) after anterior cervical discectomy in patients exclusively suffering from radiculopathy, and to evaluate differences with mixed patient populations. Comparing these data to the mixed population data demonstrated comparable mean values, except for the 2-year follow-up NDI values in the prosthesis group: mixed group patients that received a prosthesis reported a mean NDI score
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