Mid- and long-term outcomes of cervical disc arthroplasty versus anterior cervical discectomy and fusion for single-level cervical spondylosis: a meta-analysis

doi:10.3969/j.issn.2095-4344.2017.15.026

Abstract

Abstract:

BACKGROUND: Anterior cervical discectomy and fusion (ACDF) is the gold standard for degenerative cervical disease, which would be replaced by cervical disc arthroplasty (CDA) with the wide application of CDA. But, the mid- and long-term outcomes of ACDF versus CDA remain controversial.

OBJECTIVE: To compare the mid- and long-term outcomes of ACDF and CDA in the treatment of single-level cervical spondylosis.

METHODS: PubMed, Medline, EMbase, Cochrane, CBM, CNKI, VIP and WanFang databases were searched for randomized controlled trials addressing CDA versus ACDF for single-level cervical spondylosis published before August 2016. The quality of trails was strictly evaluated, the data were extracted and a meta-analysis was performed on ReviewManager5.3 software.

RESULTS AND CONCLUSION: (1) Totally 15 randomized controlled trials involving 2 781 patients were included, with 4-10 years of follow-up. (2) Meta-analysis results showed that compared with ACDF, CDA had better SF-36 scores, larger range of motion at operation level, lower the Neck Disability Index, and Visual Analogue Scale scores for arm pain, lower reoperation rate at operation level and adjacent level at mid- and long-term follow-up. (3) The Visual Analogue Scale scores for neck pain, neurologic success and all-complication rate did not differ significantly between two groups. (4) These results manifest that CDA is superior to ACDF in the mid- and long-term outcomes for single-level cervical spondylosis; however, further large-scale, multi-center and high-quality randomized controlled trials will be necessary.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Cervical Vertebrae, Intervertebral Disk, Systems Analysis, Tissue Engineering

CLC Number:

R318

Chen Bo, Qu Xia, Tao Yuan, Luo Cheng, Yang Lin, Zou Yong-gen. Mid- and long-term outcomes of cervical disc arthroplasty versus anterior cervical discectomy and fusion for single-level cervical spondylosis: a meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2017, 21(15): 2444-2452.

Figures/Tables 4

2.2 Meta分析结果 2.2.1 SF-36评分纳入3项研究[22-23，26]，各研究间无统计学异质性(P=0.58，I2=0%)，采用固定效应模型。两组差异有显著性意义(SMD= 0.23，95% CI：0.08-0.37，P=0.002)，表示颈椎间盘置换组比颈前路减压植骨融合组术后生活质量好，见图2。 2.2.2 NDI评分纳入11项研究[21，23-28，30，33-35]，各研究间无统计学异质性(P=0.59，I2=0%)，采用固定效应模型。两组差异有显著性意义(SMD=-0.27，95% CI：-0.37至-0.17，P < 0.000 01)，表示颈前路减压植骨融合组比颈椎间盘置换组术后颈部功能受限更明显，见图3。 2.2.3 神经功能改善率纳入5项研究[21。23。26。28-29]，各研究间有统计学异质性(P < 0.000 01，I2=87%)，采用随机效应模型。两组差异无显著性意义(RR=1.04，95% CI：0.93-1.16，P=0.47)，见图4。 2.2.4 颈痛目测类比评纳入6项研究[23-24，26，30，34-35]，各研究间有统计学异质性(P < 0.000 01，I2=99%)，采用随机效应模型。两组差异无显著性意义(RR=-0.86，95% CI:-2.32-0.60，P=0.25)，见图5。 2.2.5 臂痛目测类比评分纳入6项研究[23-24，26。30。34-35]，各研究间无统计学异质性(P=0.35，I2=10%)，采用固定效应模型。两组差异有显著性意义(SMD=-0.14，95% CI：-0.27至-0.01，P=0.03)，表示颈椎间盘置换组比颈前路减压植骨融合组术后上肢疼痛较轻，见图6。 2.2.6 手术节段活动度纳入7项研究[23-24，28-31，33]，各研究间有统计学异质性(P < 0.000 01，I2=99%)，采用随机效应模型。两组差异有显著性意义(RR=7.09，95% C：4.18-10.00，P < 0.000 1)，表示颈椎间盘置换组比颈前路减压植骨融合组术后颈椎活动范围大，见图7。 2.2.7 邻近节段再手术率纳入15项研究[21-35]，各研究间无统计学异质性(P=0.38，I2=7%)，采用固定效应模型。两组差异有显著性意义(RR=0.50，95% CI：0.35-0.72，P < 0.000 1)，表示颈椎间盘置换组比颈前路减压植骨融合组术后邻近节段再手术率低，见图8。 2.2.8 手术节段再手术率纳入14项研究[21-34]，各研究间无统计学异质性(P=0.67，I2=0%)，采用固定效应模型。两组差异有显著性意义(RR=0.43，95% CI：0.31-0.59，P < 0.000 01)，表示颈椎间盘置换组比颈前路减压植骨融合组术后手术节段再手术率低，见图9。 2.2.9 总并发症率纳入8项研究[22-25，27-30]，各研究间无统计学异质性(P=0.43，I2=0%)，采用固定效应模型。两组差异无显著性意义(RR=1.12，95% CI：0.93-1.36，P=0.24)，见图10。"

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