Abstract
Anterior cervical discectomy and fusion (ACDF) and total cervical disc replacement (TDR) are considered effective treatments for patients with cervical degenerative disc disease (CDDD). An indirect meta-analysis including 19 randomized controlled trials (5343 patients) was conducted to compare the clinical outcomes of ACDF with TDR. Primary outcomes including functional indicators (NDI [neck disability index] score, neurological success and patient satisfaction), secondary outcomes including surgical outcomes (operation time, blood loss and length of stay) and secondary surgical procedures (secondary surgery at an adjacent level, secondary surgery at the index level, secondary surgery at both levels, removal, reoperation, revision and supplemental fixation) were included in the study. TDR using the Bryan disc was associated with a greater improvement in NDI score than ACDF (MD = −5.574, 95% CrIs [credible intervals] −11.73–−0.219). For neurological success, the Bryan (odds ratio [OR] = 0.559, 95% CrIs 0.323–0.955) and Prestige (OR = 0.474, 95% CrIs 0.319–0.700) discs were superior to ACDF. However, no differences in the patient satisfaction rate were shown between TDR and ACDF. For patients with CDDD, ACDF using allograft and a plate is most effective for determining the surgical parameters. Moreover, TDR using the ProDisc-C, Mobi-C, Prestige and Bryan discs are good choices for improving functional outcomes and reducing secondary surgeries.
Highlights
Anterior cervical discectomy and fusion (ACDF) is considered the traditional standard operation and is widely performed to treat cervical degenerative disc disease (CDDD)[1, 2]
The aim of this study was to perform an indirect meta-analysis to estimate the relative effectiveness of each type of Total cervical disc replacement (TDR) or ACDF using different implants on surgical parameters including operative time, blood loss and length of stay, functional indicators including the Neck Disability Index (NDI) score, Short Form 36 (SF-36) Physical Component Score (PCS), SF-36 Mental Component Score (MCS), Visual Analogue Scale (VAS) neck pain score, VAS arm pain score, neurological success, patient satisfaction, return-to-work status and secondary surgical procedures including secondary surgery at an adjacent level, both levels, the index level and removal, reoperation, revision, and supplemental fixation
Regarding NDI scores, the results showed that TDR with the Bryan disc was significantly more effective than ACDF using allograft bone and a plate (MD = −5.574, 95% credible intervals (CrIs) −11.73–−0.219) (Table 2)
Summary
Anterior cervical discectomy and fusion (ACDF) is considered the traditional standard operation and is widely performed to treat cervical degenerative disc disease (CDDD)[1, 2]. TDR may lead to complications including heterotopic ossification, erosion of the replacements and increased flexibility of the adjacent cervical disc level. The clinical effectiveness among TDR using different replacements and ACDF using different implants remain unresolved. The aim of this study was to perform an indirect meta-analysis to estimate the relative effectiveness of each type of TDR or ACDF using different implants on surgical parameters including operative time, blood loss and length of stay, functional indicators including the Neck Disability Index (NDI) score, Short Form 36 (SF-36) Physical Component Score (PCS), SF-36 Mental Component Score (MCS), Visual Analogue Scale (VAS) neck pain score, VAS arm pain score, neurological success, patient satisfaction, return-to-work status and secondary surgical procedures including secondary surgery at an adjacent level, both levels, the index level and removal, reoperation, revision, and supplemental fixation
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