title: Systematic review and meta-analysis of randomized controlled trials: comparison of total disk replacement with anterior cervical decompression and fusion.
abstract: The authors performed a systematic review and meta-analysis to evaluate whether there is a beneficial clinical effect of total disk replacement compared with anterior cervical diskectomy and fusion for the treatment of single-level symptomatic cervical disk disease. A comprehensive literature search of multiple databases, including PubMed (1966-2011), Cochrane Controlled Trials Register (CENTRAL; issue 1, 2011), and Embase (1984-2011), was conducted to identify studies that met the inclusion criteria. Methodologic quality was assessed and relevant data were retrieved, and if appropriate, meta-analysis was performed. Eight randomized controlled trials were identified; six of the 8 reported 24-month follow-up results. At 24 months, total disk replacement was demonstrated to be more beneficial for patients compared with anterior cervical diskectomy and fusion for the following outcomes: overall success rate (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.37-2.33; P<.0001), overall reoperation rate (OR,.36; CI, .21-.61; P=0), reoperation rate for revision (OR, .12; CI, .02 to .64; P=.01), and visual analog scale neck pain scores (standard mean differences [SMD], -.48; CI, -.91 to -.05; P=.03). Other outcomes, including Neck Disability Index scores (SMD, -.02; CI, -.44 to .27; P=.67) and visual analog scale arm pain scores (SMD, -.21; CI, -.63 to .22; P=.34), demonstrated no differences between the 2 groups. For patients with single-level symptomatic cervical disk disease, total disk replacement was found to be more effective than anterior cervical diskectomy and fusion in the 2 outcomes of overall success rate and overall reoperation rate at 24 months. Long-term results also showed total disk replacement trended to be more effective than anterior cervical diskectomy and fusion in some aspects.
authors.affiliation: Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, People’s Republic of China.
authors.forename: Lin
authors.initials: L
authors.lastname: Yu
authors.forename: Yueming
authors.initials: Y
authors.lastname: Song
authors.forename: Xi
authors.initials: X
authors.lastname: Yang
authors.forename: Chaoliang
authors.initials: C
authors.lastname: Lv
mesh_terms: D002574:Cervical Vertebrae / Q000601:surgery*; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods*; D017586:Diskectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D019547:Neck Pain / Q000209:etiology; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D012086:Reoperation; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D059145:Total Disc Replacement / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome