Comparison of artificial cervical arthroplasty versus anterior cervical discectomy and fusion for one-level cervical degenerative disc disease: a meta-analysis of randomized controlled trials

Abstract

For patients with one-level CDDD, TDR was found to be more superior than ACDF in terms of neurological success, secondary surgical procedures, visual analogue scale pain scores and range of motion at 24 months post-operatively. Therefore, cervical arthroplasty is a safe and effective surgical procedure for treating one-level CDDD. We suggest adopting TDR on a large scale; with failure of TDR, ACDF would be performed.

The Norwegian Cervical Arthroplasty Trial (NORCAT): 2-year clinical outcome after single-level cervical arthroplasty versus fusion—a prospective, single-blinded, randomized, controlled multicenter study

“…In addition, differences between surgical techniques are also key factors to consider. In the present trial, patients operated with arthroplasty had significantly longer duration of surgery, which corresponds to the results from a newly published meta-analysis [15]. Even though experienced spinal surgeons operated the patients, all surgeons were more familiar with the fusion procedure as it was the standard treatment in the departments involved.…”

“…However, statistical analyses using linear mixed models that adjust for baseline values, dropout and missing data showed a difference in self-rated neck disability and the numeric rating score for arm pain in favor of fusion after 2 years. This is not consistent with most randomized controlled trials [6][7][8][9][10][11][12], the recent study on available registry data by Staub and colleagues [29], and three recent meta-analyses [15][16][17] reporting clinical outcome in favor of arthroplasty. The between-group difference in NDI score of 5.9%, shown in the present study is small and the statistical significance is weak, and the results must, therefore, be interpreted with caution.…”

“…Multiple trials [6][7][8][9][10][11][12][13][14] and three recent meta-analyses [15][16][17] have compared the results of arthroplasty versus fusion. Most authors concluded with clinical outcome in favor of arthroplasty [6][7][8][9][10][11][12][15][16][17].…”

“…Most authors concluded with clinical outcome in favor of arthroplasty [6][7][8][9][10][11][12][15][16][17]. However, few trials included blinding of patients [15], and blinding was only performed until just after the surgical procedure was completed [7,11].…”

Cervical disc replacement surgery: indications, technique, and technical pearls

“…CDR emerged in the 1960s as a means of minimizing the biomechanical stress placed on adjacent levels following a fusion procedure; however, these early devices were fraught with high complication rates and poor results [9,10]. Decades of technological advancements have lead to the current devices available to spine surgeons, some of which have produced excellent mid-term results [11][12]13••, [14][15]. Cadaveric studies have supported these findings from a biomechanical standpoint, and several investigations have shown superior patient outcomes, higher patient satisfaction, less implant related complications, and lower reoperation rates in comparing CDR with ACDF [8,14,[16][17][18].…”