title: Is cervical disc arthroplasty superior to fusion for treatment of symptomatic cervical disc disease? A meta-analysis.
abstract: BACKGROUND
  As the current standard treatment for symptomatic cervical disc disease, anterior cervical decompression and fusion may result in progressive degeneration or disease of the adjacent segments. Cervical disc arthroplasty was theoretically designed to be an ideal substitute for fusion by preserving motion at the operative level and delaying adjacent level degeneration. However, it remains unclear whether arthroplasty achieves that aim.
  
  
  OBJECTIVE
  We investigated whether cervical disc arthroplasty was associated with (1) better function (neck disability index, pain assessment, SF-36 mental and physical health surveys, neurologic status) than fusion, (2) a lower incidence of reoperation and major complications, and (3) a lower risk of subsequent adjacent segment degeneration.
  
  
  METHODS
  We conducted a comprehensive search in MEDLINE(®), EMBASE, and Cochrane Central Register of Controlled Trials and identified 503 papers. Of these, we identified 13 reports from 10 randomized controlled trials involving 2227 patients. We performed a meta-analysis of functional scores, rates of reoperation, and major complications. The strength of evidence was evaluated by using GRADE profiler software. Of the 10 trials, six trials including five prospective multicenter FDA-regulated studies were sponsored by industry. The mean follow-ups of the 10 trials ranged from 1 to 5 years.
  
  
  RESULTS
  Compared with anterior cervical decompression and fusion, cervical disc arthroplasty had better mean neck disability indexes (95% CI, -0.25 to -0.02), neurologic status (risk ratio [RR], 1.04; 95% CI, 1.00-1.08), with a reduced incidence of reoperation related to the index surgery (RR, 0.42; 95% CI, 0.22-0.79), and major surgical complications (RR, 0.45; 95% CI, 0.27-0.75) at a mean of 1 to 3 years. However, the operation rate at adjacent levels after two procedures was similar (95% CI, 0.31-1.27). The three studies with longer mean follow-ups of 4 to 5 years also showed similar superiority of all four parameters of cervical disc arthroplasty compared with fusion.
  
  
  CONCLUSIONS
  For treating symptomatic cervical disc disease, cervical disc arthroplasty appears to provide better function, a lower incidence of reoperation related to index surgery at 1 to 5 years, and lower major complication rates compared with fusion. However, cervical disc arthroplasty did not reduce the reoperation rate attributable to adjacent segment degeneration than fusion. Further, it is unclear whether these differences in subsequent surgery including arthroplasty revisions will persist beyond 5 years.
authors: Department of Orthopaedic Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Yantawest Road, Xi'an, China.
authors: Si
authors: S
authors: Yin
authors: Xiao
authors: X
authors: Yu
authors: Shuangli
authors: S
authors: Zhou
authors: Zhanhai
authors: Z
authors: Yin
authors: Yusheng
authors: Y
authors: Qiu
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000601:surgery; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods*; D004185:Disability Evaluation; D017586:Diskectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006304:Health Status; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000503:physiopathology; D010147:Pain Measurement; D011183:Postoperative Complications; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D012086:Reoperation; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D059145:Total Disc Replacement / Q000009:adverse effects / Q000379:methods*
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