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| CHEN Bo,JIN Gele,YANG Yi.Meta-analysis on the mid-term effects of cervical disc arthroplasty versus anterior cervical discectomy and fusion for single-level cervical spondylosis[J].Chinese Journal of Spine and Spinal Cord,2014,(6):517-525. |
| Meta-analysis on the mid-term effects of cervical disc arthroplasty versus anterior cervical discectomy and fusion for single-level cervical spondylosis |
| Received:December 24, 2013 Revised:February 21, 2014 |
| English Keywords:Cervical disc arthroplasty Anterior cervical discectomy and fusion Mid-term effects Meta-analysis Systematic review Randomized controlled trial |
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| 【Abstract】 Objectives: To assess the mid-term effects of cervical disc arthroplasty(CDA) versus anterior cervical discectomy and fusion(ACDF) for single-level cervical spondylosis． Methods: According to the method of systematic review of Cochrane, PubMed, Medline, EMBASE, Cochrane Library, CBM, CNKI, VIP database, Wanfang database before October 1st, 2013 were searched for articles comparing CDA and ACDF for single-level cervical spondylosis． All randomized controlled trials(RCTs) were included for the present study. Two authors independently assessed trial quality and extracted data． Data of NDI score, SF-36 score, rate of neurologic success, VAS score of neck pain, VAS score of arm pain, range of motion in operation level, reoperation rate at operation level, reoperation rate at adjacent level, total complication rate at last follow-up after operation from these studies were abstracted and synthesized by Review Manager 5.2 for Meta-analysis． Results: Seven studies with a total of 1622 patients were included(826 in the CDA group and 796 in the ACDF group, with 4-5 year follow-up)． The methodological quality score of studies included in the Meta-analysis was from 4 to 6． Of them, two studies were score 4, three studies is score 5 and the other two studies is score 6． Meta-analysis indicated that no differences were found in the rate of neurologic success[(RR= 1.04, 95%CI(1.00, 1.09), P=0.07], VAS score of neck pain[SMD=-0.12, 95%CI(-0.27, 0.04), P=0.13] and the total complication rate[RR=1.06, 95%CI(0.57, 1.96), P=0.86] between two groups. Compared with ACDF, CDA had better SF-36 score[SMD=0.24, 95%CI(0.08, 0.39), P=0.003], larger range of motion in operation level[SMD=7.38, 95%CI(5.87, 8.89), P<0.00001], lower NDI score[SMD=-0.26, 95%CI(-0.40, -0.13), P=0.0002), lower VAS score of arm pain[SMD=-0.17, 95%CI(-0.33, 0.02), P=0.03), lower reoperation rate at operation level[RR=0.48, 95%CI(0.31, 0.75), P=0.001] and lower reoperation rate at adjacent levels[RR=0.60,95%CI(0.37, 0.98), P=0.04] at mid-term follow-up. Conclusions: For single-level cervical spondylosis, CDA appears to provide better clinical effects than ACDF at mid-term follow-up. |
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