No justification for cervical disk prostheses in clinical practice: a meta-analysis of randomized controlled trials.
OBJECTIVE
A meta-analysis was performed to evaluate whether a beneficial clinical effect of cervical disk prostheses over conventional cervical diskectomy with fusion exists.


METHODS
A literature search was completed ending February 4, 2009, that included the abstract books of recent major spine congresses. All studies reported the results of single-level cervical disease without myelopathy. The Visual Analog Score (VAS) of the arm, VAS of the neck, Neck Disability Index, Physical Composite Scores of the Short Form 36, and Mental Composite Score of the Short Form 36, as well as adverse events, were evaluated.


RESULTS
Nine records were found, totaling 1533 patients. Of these, 1165 were evaluable at the last follow-up at 12 or 24 months. As an effect measure, a pooled odds ratio (OR) was calculated at 12 and 24 months. At 12 months, the VAS arm reached statistical significance (OR = 0.698; 95% confidence interval [CI], 0.571-0.853), as did the VAS neck (OR = 0.690; 95% CI, 0.562-0.847), and the Physical Composite Scores (OR = 1.362; 95% CI, 1.103-1.682) and the Mental Composite Score (OR = 1.270; 95% CI, 1.029-1.569) of the Short Form 36, favoring arthroplasty. The Neck Disability Index at 24 months also reached statistical difference (OR = 0.794; 95% CI, 0.641-0.984). All other measurements did not reveal any statistical difference. The number of complications, including secondary surgeries for adjacent segment disease, did not differ.


CONCLUSIONS
A clinical benefit for the cervical disk prosthesis is not proven. Because none of the studies were blinded, bias of the patient or researcher is a probable explanation for the differences found. Therefore, these costly devices should not be used in daily clinical practice.
Bartels
Ronald H M A
RH
Radboud University Nijmegen Medical Centre, Department of Neurosurgery, Nijmegen, Netherlands. r.bartels@nch.umcn.nl
Donk
Roland
R
Verbeek
André L M
AL
D017586:Diskectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods / Q000592:standards; D006801:Humans; D007403:Intervertebral Disc / Q000033:anatomy & histology / Q000502:physiology / Q000601:surgery*; D007405:Intervertebral Disc Displacement / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D019736:Prostheses and Implants / Q000009:adverse effects / Q000592:standards* / Q000639:trends; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D016032:Randomized Controlled Trials as Topic / Q000379:methods* / Q000592:standards; D018570:Risk Assessment; D055009:Spondylosis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*