title: Systematic review of anterior interbody fusion techniques for single- and double-level cervical degenerative disc disease.
abstract: METHODS
  A systematic review of randomized controlled trials.
  
  
  OBJECTIVE
  To determine which technique of anterior cervical interbody fusion (ACIF) gives the best outcome in patients with cervical degenerative disc disease.
  
  
  BACKGROUND
  The number of surgical techniques for decompression and ACIF as treatment for cervical degenerative disc disease has increased rapidly, but the rationale for the choice between different techniques remains unclear.
  
  
  METHODS
  From a comprehensive search, we selected randomized studies that compared anterior cervical decompression and ACIF techniques, in patients with chronic single- or double-level degenerative disc disease or disc herniation. Risk of bias was assessed using the criteria of the Cochrane back review group.
  
  
  RESULTS
  Thirty-three studies with 2267 patients were included. The major treatments were discectomy alone and addition of an ACIF procedure (graft, cement, cage, and plates). At best, there was very low-quality evidence of little or no difference in pain relief between the techniques. We found moderate quality evidence for few secondary outcomes. Odom's criteria were not different between iliac crest autograft and a metal cage (risk ratio [RR]: 1.11; 95% confidence interval [CI]: 0.99-1.24). Bone graft produced more fusion than discectomy (RR: 0.22; 95% CI: 0.17-0.48). Complication rates were not different between discectomy and iliac crest autograft (RR: 1.56; 95% CI: 0.71-3.43). Low-quality evidence was found that iliac crest autograft results in better fusion than a cage (RR: 1.87; 95% CI: 1.10-3.17); but more complications (RR: 0.33; 95% CI: 0.12-0.92).
  
  
  CONCLUSIONS
  When fusion of the motion segment is considered to be the working mechanism for pain relief and functional improvement, iliac crest autograft appears to be the golden standard. When ignoring fusion rates and looking at complication rates, a cage as a golden standard has a weak evidence base over iliac crest autograft, but not over discectomy.
authors.affiliation: Department of Neurosurgery, Leiden University Medical Centre, Leiden, The Netherlands. w.c.h.jacobs@lumc.nl
authors.forename: Wilco
authors.initials: W
authors.lastname: Jacobs
authors.forename: Paul C
authors.initials: PC
authors.lastname: Willems
authors.forename: Moyo
authors.initials: M
authors.lastname: Kruyt
authors.forename: Jacques
authors.initials: J
authors.lastname: van Limbeek
authors.forename: Patricia G
authors.initials: PG
authors.lastname: Anderson
authors.forename: Paul
authors.initials: P
authors.lastname: Pavlov
authors.forename: Ronald
authors.initials: R
authors.lastname: Bartels
authors.forename: Cumhur
authors.initials: C
authors.lastname: Oner
mesh_terms: D016025:Bone Transplantation / Q000379:methods*; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery*; D017586:Diskectomy / Q000379:methods*; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic; D013123:Spinal Fusion / Q000379:methods; D014182:Transplantation, Autologous; D016896:Treatment Outcome