Abstract
PurposeTo systematically compare the efficacy and safety of lumbar total disc replacement (TDR) with the efficacy and safety of anterior lumbar interbody fusion (ALIF) for the treatment of lumbar degenerative disc disease (LDDD).MethodsThe electronic databases PubMed, Web of Science and the Cochrane Library were searched for the period from the establishment of the databases to March 2018. The peer-reviewed articles that investigate the safety and efficacy of TDR and ALIF were retrieved under the given search terms. Quality assessment must be done independently by two authors according to each item of criterion. The statistical analyses were performed using RevMan (version 5.3) and Stata (version 14.0). The random-effect model was carried out to pool the data. The I2 statistic was used to evaluate heterogeneity. The sensitivity analysis was carried out to assess the robustness of the results of meta-analyses by omitting the articles one by one.ResultsSix studies (5 randomized controlled trials (RCT) and 1 observational study) involving 1093 patients were included in this meta-analysis. The risk of bias of the studies could be considered as low to moderate. Operative time (MD = 4.95; 95% CI -18.91–28.81; P = 0.68), intraoperative blood loss (MD = 4.95; 95% CI -18.91–28.81; P = 0.68), hospital stay (MD = -0.33; 95% CI, -0.67–0.01; P = 0.05), complications (RR = 0.96; 95% CI 0.91–1.02; P = 0.18) and re-operation rate (RR = 0.54; 95% CI 0.14–2.12; P = 0.38) were without significant clinical difference between groups. Patients in the TDR group had higher postoperative satisfaction (RR = 1.19; 95% CI 1.07–1.32; P = 0.001) and, better improvements in ODI (MD = -10.99; 95% CI -21.50- -0.48; P = 0.04), VAS (MD = -10.56; 95% CI -19.99- -1.13; P = 0.03) and postoperative lumbar mobility than did patients in the ALIF group.ConclusionsThe results showed that TDR has significant superiority in term of reduced clinical symptoms, improved physical function and preserved range of motion for the treatment of LDDD compared to ALIF. TDR may be an ideal alternative for the selected patients with LDDD in the short-term. However, the results of this study cannot suggest the use of TDR instead of ALIF in lumbar spine treatment only in the light of short term results. More studies that are well-designed, that are of high-quality and that have larger samples are needed to further evaluate the efficacy and safety of TDR with at the long-term follow-up.Level of evidenceTherapeutic Level 3
Highlights
Chronic low back pain (CLBP) is generally defined as lower back pain that persists for at least 3 months or 12 weeks [1]
Operative time (MD = 4.95; 95% confidence interval (95% CI) -18.91–28.81; P = 0.68), intraoperative blood loss (MD = 4.95; 95% CI -18.91–28.81; P = 0.68), hospital stay (MD = -0.33; 95% CI, -0.67–0.01; P = 0.05), complications (RR = 0.96; 95% CI 0.91–1.02; P = 0.18) and re-operation rate (RR = 0.54; 95% CI 0.14–2.12; P = 0.38) were without significant clinical difference between groups
The results showed that total disc replacement (TDR) has significant superiority in term of reduced clinical symptoms, improved physical function and preserved range of motion for the treatment of lumbar degenerative disc disease (LDDD) compared to anterior lumbar interbody fusion (ALIF)
Summary
Chronic low back pain (CLBP) is generally defined as lower back pain that persists for at least 3 months or 12 weeks [1]. As an important part of many different fusion approaches, ALIF is not perfect It has some complications similar to other fusion approaches, such as adjacent segment degeneration [5] and postoperative fusion pain, but is associated with the risk of vascular, intestinal and nerve injury [6]. Those complications associated with the approach can be decreased through improving techniques and continuous training, the restriction in the range of motion (ROM) of the fusion segment generally cannot be changed
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