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Minimum four-year subsequent surgery rates of cervical disc replacement versus fusion: A meta-analysis of prospective randomized clinical trials - 08/02/17

Doi : 10.1016/j.otsr.2016.10.008 
T.K. Wu, H. Liu , B.Y. Wang, Y. Meng
 Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Sichuan 610041, China 

Corresponding author.

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Abstract

Instruction

Anterior cervical discectomy and fusion (ACDF) is a well-accepted surgical management strategy for radiculopathy and/or myelopathy. However, complications sometimes required subsequent surgery at the operated and adjacent levels. Artificial cervical disc replacement (ACDR) has been accepted as the most extensive non-fusion procedure and is designed to preserve motion. However, some specific complications can result in subsequent surgery, thus, attracting the attention of investigators.

Hypothesis

Compared with ACDF, ACDR had a lower subsequent surgery rates at both operated and adjacent levels after a minimum of four-years of follow-up.

Material and methods

A meta-analysis was performed with articles published prior to February 2016. Only randomized controlled trials that reported a minimum of 4 years of follow-up with regard to the rates of subsequent surgeries after ACDR compared with ACDF were included in this study. Two reviewers independently screened the articles and data following the PRISMA statement.

Results

Our data showed that the pooled overall rate of subsequent surgery at the operated level and adjacent levels was lower in the ACDR group (7.4%) than in the ACDF group (16.8%) (P=0.0006). For subsequent surgery at the operated level, patients who received ACDR had a lower rate of subsequent surgery than patients who received ACDF (P<0.0001). With respect to the adjacent level, ACDR also had fewer subsequent surgeries compared with ACDF (P<0.0001).

Conclusion

ACDR had significantly fewer subsequent surgical interventions compared with ACDF, However, a review of the literature showed that there were an insufficient number of studies with respect to subsequent surgery with a minimum of 4 years of follow-up. Hence, longer-term, multicenter studies are needed for better evaluation of the rate of subsequent surgery after ACDR.

Level of evidence

Level I, meta-analysis of high-powered prospective randomized trials.

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Keywords : Cervical disc replacement, Fusion, Subsequent surgery


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© 2016  Elsevier Masson SAS. Tous droits réservés.
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Vol 103 - N° 1

P. 45-51 - février 2017 Retour au numéro
Article précédent Article précédent
  • Comparison between total disc replacement and hybrid construct at two lumbar levels with minimum follow-up of two years
  • K. Andrieu, J. Allain, P.-M. Longis, J.-P. Steib, J. Beaurain, J. Delécrin
| Article suivant Article suivant
  • Cervical sagittal alignment in adult hyperkyphosis treated by posterior instrumentation and in situ bending
  • F. Paternostre, Y.P. Charles, E.A. Sauleau, J.-P. Steib

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