Clinical Outcomes of Treating Cervical Adjacent Segment Disease by Anterior Cervical Discectomy and Fusion Versus Total Disc Replacement: A Systematic Review and Meta-Analysis

Lu, Victor M.; Mobbs, Ralph J.; Phan, Kevin

doi:10.1177/2192568218789115

Cited by 14 publications

(8 citation statements)

References 28 publications

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“…In a recent systematic review and meta-analysis, the authors discovered shorter operative times among patients receiving CDR, in contrast to our findings. 19 However, estimated blood was statistically similar for both surgeries, as we reported. Similarly, in a meta-analysis by Wu et al comparing multiple-level CDR versus ACDF, no such difference was found for operative duration or blood loss among the two procedures.…”

Section: Perioperative Outcomessupporting

confidence: 79%

Anterior Cervical Discectomy and Fusion Versus Cervical Disc Replacement for a Workers’ Compensation Population in an Ambulatory Surgical Center

Patel,

Jacob,

Prabhu

et al. 2023

Clinical Spine Surgery: A Spine Publication

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Study Design: Retrospective Cohort. Objective: To evaluate patient-reported outcome measures (PROM) and minimal clinically important difference (MCID) achievement outcomes between anterior cervical discectomy and fusion (ACDF) and cervical disk replacement (CDR) in the Workers’ Compensation (WC) population. Summary of Background Data: No studies to our knowledge have compared PROMs and MCID attainment between ACDF and CDR among patients with WC insurance undergoing surgery in an outpatient ambulatory surgical center (ASC). Methods: WC insurance patients undergoing primary, single/double-level ACDF/CDR in an ASC were identified. Patients were divided into ACDF versus CDR. PROMs were collected at preoperative/6-week/12-week/6-month/1-year timepoints, including PROMIS-PF, SF-12 PCS/MCS, VAS neck/arm, and NDI. Results: Seventy-nine patients were included, 51 ACDF/28 CDR. While operative time (56.4 vs. 54.4 min), estimated blood loss (29.2 vs. 25.9 mL), POD0 pain (4.9 vs. 3.8), and POD0 narcotic consumption (21.2 vs. 14.5 oral morphine equivalents) were higher in ACDF patients, none reached statistical significance (P>0.050, all). One-year arthrodesis rate was 100.0% among ACDF recipients with available imaging (n=36). ACDF cohort improved from preoperative for PROMIS-PF from 12 weeks to 1 year, SF-12 PCS at 6 months, all timepoints for VAS neck/arm, and 12 weeks/6 months for NDI (P≤0.044, all). CDR cohort improved from preoperative for PROMIS-PF at 6 months, VAS neck/arm from 12 weeks to 1 year, and NDI at 12 weeks/6 months (P≤0.049, all). CDR cohort reported significantly lower VAS neck at 12 weeks/1 year and VAS arm at 12 weeks (P≤0.039, all). MCID achievement rates did not differ. Conclusion: While operative duration/estimated blood loss/acute postoperative pain/narcotic consumption were, on average, higher among ACDF recipients, these were not statistically significant, possibly due to the limited sample size. ACDF and CDR ASC patients generally demonstrated comparable arm pain/disability/physical function/mental health, though neck pain was significantly lower at multiple timepoints among CDR patients. Clinically meaningful PROM improvements were comparable. Larger, multicentered studies are required to confirm our results.

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Section: Perioperative Outcomessupporting

confidence: 79%

Anterior Cervical Discectomy and Fusion Versus Cervical Disc Replacement for a Workers’ Compensation Population in an Ambulatory Surgical Center

Patel,

Jacob,

Prabhu

et al. 2023

Clinical Spine Surgery: A Spine Publication

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“…Several reports unanimously demonstrated the clinical efficacy and safety of such a strategy. 41,58,59 However, studies with larger patient numbers and longer follow-up are mandatory to compare the efficacy of treating ASD with CDA and ACDF. Also, more studies are needed to elucidate the best combination strategy for different designs of the hybrid construct when it comes to different spondylotic conditions among various levels.…”

Section: Hybrid Cda-acdf Surgerymentioning

confidence: 99%

Multilevel cervical disc arthroplasty: a review of optimal surgical management and future directions

Wang

Chen

et al. 2023

Journal of Neurosurgery: Spine

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OBJECTIVE Cervical disc arthroplasty (CDA) has been recognized as a popular option for cervical radiculopathy or myelopathy caused by disc problems that require surgery. There have been prospective randomized controlled trials comparing CDA to anterior cervical discectomy and fusion (ACDF) for 1- and 2-level disc herniations. However, the indications for CDA have been extended beyond the strict criteria of these clinical trials after widespread real-world experiences in the past decade. This article provides a bibliometric analysis with a review of the literature to understand the current trends of clinical practice and research on CDA. METHODS The PubMed database was searched using the keywords pertaining to CDA in human studies that were published before August 2022. Analyses of the bibliometrics, including the types of papers, levels of evidence, countries, and the number of disc levels involved were conducted. Moreover, a systematic review of the contents with the emphasis on the current practice of multilevel CDA and complex cervical disc problems was performed. RESULTS A total of 957 articles published during the span of 22 years were analyzed. Nearly one-quarter of the articles (232, 24.2%) were categorized as level I evidence, and 33.0% were categorized as levels I or II. These studies clearly demonstrated the viability and effectiveness of CDA regarding clinical and radiological outcomes, including neurological improvement, maintenance, and preservation of segmental mobility with relatively low risks for several years postoperation. Also, there have been more papers published during the last decade focusing on multilevel CDA and fewer involving the comparison of ACDF. Overall, there was a clustering of CDA papers published from the US and East Asian countries. Based on substantial clinical data of CDA for 1- and 2-level disc diseases, the practice and research of CDA show a trend toward multilevel and complex disease conditions. CONCLUSIONS CDA is an established surgical management procedure for 1- and 2-level cervical disc herniation and spondylosis. The success of motion preservation by CDA—with low rates of complications—has outscored ACDF in patients without deformity. For more than 2-level disc diseases, the surgery shows a trend toward multiple CDA or hybrid ACDF–CDA according to individual evaluation for each level of degeneration.

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“…Bin et al 53 reported on the treatment of 32 patients who had ASD treated with a CDA at the adjacent level and found good clinical outcomes with a maintained range-of-motion at the CDA level. In a systematic review by Lu et al, 54 the treatment of adjacent-level disease by ACDF versus CDA found that CDA had similar surgical and postoperative outcomes to the treatment of ASD as ACDF.…”

Section: Multi-level (3-level or 4-level) Cdamentioning

confidence: 99%

Current and Expanded Indications for Cervical Disc Arthroplasty

Divi,

Plantz,

Tegethoff

et al. 2023

Clinical Spine Surgery: A Spine Publication

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The widespread success of cervical disc arthroplasty (CDA) has led to an interest in expanding indications beyond those outlined in the initial Food and Drug Administration investigational device exemption studies. Some of these off-label indications currently include 3-level and 4-level CDA, hybrid constructs with adjacent segment anterior cervical discectomy and fusion or corpectomy constructs, pre-existing kyphosis, revision of a failed anterior cervical discectomy and fusion to a CDA, CDA in the setting of significant degenerative disc disease and/or facet joint arthropathy, CDA for congenital cervical stenosis, and CDA in the presence of ossification of the posterior longitudinal ligament. This review article will summarize the current literature pertaining to the aforementioned indications.

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Clinical Outcomes of Treating Cervical Adjacent Segment Disease by Anterior Cervical Discectomy and Fusion Versus Total Disc Replacement: A Systematic Review and Meta-Analysis

Cited by 14 publications

References 28 publications

Anterior Cervical Discectomy and Fusion Versus Cervical Disc Replacement for a Workers’ Compensation Population in an Ambulatory Surgical Center

Anterior Cervical Discectomy and Fusion Versus Cervical Disc Replacement for a Workers’ Compensation Population in an Ambulatory Surgical Center

Multilevel cervical disc arthroplasty: a review of optimal surgical management and future directions

Current and Expanded Indications for Cervical Disc Arthroplasty

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