Clinical Outcome of Anterior Cervical Discectomy and Fusion versus Total Disc Replacement – A Meta-Analysis of 2532 Cases

Abstract

Purpose: Cervical total disc replacement (TDR) has become an alternative to fusion (ACDF) in the surgical treatment of cervical radiculopathy with the promise of preserving motion in the affected segment and of avoiding accelerated degeneration of the adjacent levels. Nowadays there are numerous prospective, randomised and controlled studies comparing the clinical outcome of patients with both therapeutical options. Since cervical prostheses are much more expensive than cages it is crucial to compare the clinical benefit of both implants on the basis of a larger amount of patient data. Methods: A systematic data base search and study review identified 11 prospective, randomized and controlled studies that compared the clinical outcome after ACDF or TDR using at least the scores of NDI, VAS for neck pain and VAS for arm pain after a follow-up of at least 2 years. 2532 cases were included in the statistical analysis that compared the mean values of the clinical scores. Results: There were no statistically significant difference between the ACDF group and the TDR group in the clinical outcome scores (NDI, VAS neck, VAS arm) 2 years after surgery although some of the included studies found differences. Conclusion: ACDF and cervical TDR generate the same clinical results 2 years after surgery in regard to pain relief. Some of the included studies give proof of a better range of motion and less adjacent level degeneration in the TDR group. Thus, this more expensive option is only indicated in younger patients with soft-disc herniation.