A Meta-Analysis Comparing the Results of Cervical Disc Arthroplasty with Anterior Cervical Discectomy and Fusion (ACDF) for the Treatment of Symptomatic Cervical Disc Disease

Gao, Yu; Liu, Ming; Li, Tao; Huang, Fuguo; Tang, Tian; Xiang, Zhou

doi:10.2106/jbjs.k.00599

Cited by 118 publications

(80 citation statements)

References 21 publications

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“…[9][10][11][12][13][14]16 We therefore sought to determine which of these procedures has the greater long-term expense for society. Based on the best available current data, our study finds that the long-term costs of CDA are significantly lower than that of ACDF.…”

Section: Discussionmentioning

confidence: 99%

“…10 On the other hand, another meta-analysis by Gao et al of 27 randomized controlled studies demonstrated shorter operative times and blood loss for ACDF compared to CDA. 16 Two prior studies have examined the costeffectiveness of ACDF compared to CDA. Warren et al compared outcomes at two years for a small group of 28 patients, finding both ACDF and CDA to be cost-effective at a $50,000 willingness-to-pay threshold, although the authors found a higher increase in quality-adjusted life years (QALYs) in the ACDF group.…”

Section: Introductionmentioning

confidence: 99%

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Long Term Societal Costs of Anterior Discectomy and Fusion (ACDF) versus Cervical Disc Arthroplasty (CDA) for Treatment of Cervical Radiculopathy

et al. 2016

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Background Current literature suggests that anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) have comparable clinical outcomes for the treatment of cervical radiculopathy. Given similar outcomes, an understanding of differences in long-term societal costs can help guide resource utilization. The purpose of this study was to compare the relative long-term societal costs of anterior cervical discectomy and fusion (ACDF) to cervical disc arthroplasty (CDA) for the treatment of single level cervical disc disease by considering upfront surgical costs, lost productivity, and risk of subsequent revision surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Long Term Societal Costs of Anterior Discectomy and Fusion (ACDF) versus Cervical Disc Arthroplasty (CDA) for Treatment of Cervical Radiculopathy

et al. 2016

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“…There have been several meta-analysis and systematic reviews that assess the safety and efficacy of C-ADR versus ACDF. Results in these reviews showed that C-ADR is the same or slightly superior to ACDF in morbidity or neurological success [31][32][33][34]. However, these analyses were all limited 24:2023-2032 2029 in the comparison between the two surgical procedures.…”

Section: Discussionmentioning

confidence: 99%

Factors that may affect outcome in cervical artificial disc replacement: a systematic review

Kang

Shi

et al. 2015

Eur Spine J

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“…[7][8][9] This theoretical advantage with CDR reduces concern for adjacent segment disease caused by altered biomechanics with ACDF. 11 The differences in efficacy between CDR and ACDF have been difficult to elucidate. With the prospect of receiving US Food and Drug Administration (FDA) product approval, multiple, large, multicenter, randomized controlled trials have been performed comparing clinical outcomes between these two procedures.…”

mentioning

confidence: 99%

“…8,14 Additionally, recent meta-analyses have suggested potential superiority of CDR to ACDF in terms of clinical outcomes. 8,11 However, these comparative studies have predominately focused on single-level procedures.…”

mentioning

confidence: 99%

Two-level cervical disc replacement: perspectives and patient selection

Narain¹,

Hijji²,

Bohl³

et al. 2017

OAS

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Introduction: Cervical disc replacement (CDR) is an emerging treatment option for cervical degenerative disease. Postulated benefits of cervical disc replacement compared to anterior cervical discectomy and fusion include preserved motion at the operative segments and decreased motion at adjacent levels. Multiple studies have been performed investigating the outcomes of CDR in single-level pathology. The investigation of the use of CDR in two-level pathology is an emerging topic within the literature. Purpose: To critically evaluate the literature regarding two-level CDR in order to determine its utility compared to two-level cervical arthrodesis. Patient selection factors including indications and contraindications will also be explored. Methods: The PubMed database was searched for all articles published on the subject of twolevel CDR up until October 2016. Studies were classified by publication year, study design, sample size, follow-up interval, and conflict of interest. Outcomes were recorded from each study, and included data on patient-reported outcomes, radiographic measurements, range of motion, peri-and postoperative complications, heterotopic ossification, adjacent segment disease, reoperation rate, and total intervention cost. Results: Fourteen studies were included in this review. All studies demonstrated at least noninferiority of two-level CDR compared to both two-level arthrodesis and single-level CDR. Patient selection in two-level CDR is driven by the inclusion and exclusion criteria presented in prospective, randomized controlled trials. The most common indication is subaxial degenerative disc disease over two contiguous levels presenting with radiculopathy or myelopathy. Furthermore, costs analyses trended toward at least noninferiority of two-level CDR. Conclusion: Two-level CDR is noninferior to two-level anterior cervical discectomy and fusion in terms of both outcomes and costs. While a few studies suggested superiority of two-level CDR, the presence of significant conflicts of interest by the study authors may introduce bias. Further prospective, randomized trials without conflicts of interest are necessary to determine if two-level CDR demonstrates truly superior outcomes.

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A Meta-Analysis Comparing the Results of Cervical Disc Arthroplasty with Anterior Cervical Discectomy and Fusion (ACDF) for the Treatment of Symptomatic Cervical Disc Disease

Cited by 118 publications

References 21 publications

Long Term Societal Costs of Anterior Discectomy and Fusion (ACDF) versus Cervical Disc Arthroplasty (CDA) for Treatment of Cervical Radiculopathy

Long Term Societal Costs of Anterior Discectomy and Fusion (ACDF) versus Cervical Disc Arthroplasty (CDA) for Treatment of Cervical Radiculopathy

Factors that may affect outcome in cervical artificial disc replacement: a systematic review

Two-level cervical disc replacement: perspectives and patient selection

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