title: A meta-analysis comparing the results of cervical disc arthroplasty with anterior cervical discectomy and fusion (ACDF) for the treatment of symptomatic cervical disc disease.
abstract: BACKGROUND
  Anterior cervical discectomy and fusion is a standard treatment for symptomatic cervical disc disease, but pseudarthrosis and accelerated adjacent-level disc degeneration may develop. Cervical disc arthroplasty was developed to preserve the kinematics of the functional spinal unit. Trials comparing arthroplasty with anterior cervical discectomy and fusion have shown unclear benefits in terms of clinical results, neck motion at the operated level, adverse events, and the need for secondary surgical procedures.
  
  
  METHODS
  Only randomized clinical trials were included in this meta-analysis, and the search strategy followed the requirements of the Cochrane Library Handbook. Two reviewers independently assessed the methodological quality of each included study and extracted the relevant data.
  
  
  RESULTS
  Twenty-seven randomized clinical trials were included; twelve studies were Level I and fifteen were Level II. The results of the meta-analysis indicated longer operative times, more blood loss, lower neck and arm pain scores reported on a visual analog scale, better neurological success, greater motion at the operated level, fewer secondary surgical procedures, and fewer such procedures that involved supplemental fixation or revision in the arthroplasty group compared with the anterior cervical discectomy and fusion group. These differences were significant (p < 0.05). The two groups had similar lengths of hospital stay, Neck Disability Index scores, and rates of adverse events, removals, and reoperations (p > 0.05).
  
  
  CONCLUSIONS
  The meta-analysis revealed that anterior cervical discectomy and fusion was associated with shorter operative times and less blood loss compared with arthroplasty. Other outcomes after arthroplasty (length of hospital stay, clinical indices, range of motion at the operated level, adverse events, and secondary surgical procedures) were superior or equivalent to the outcomes after anterior cervical discectomy and fusion.
authors.affiliation: Department of Orthopaedic Surgery, West China Hospital of Sichuan University, Guoxuexiang Street #37, Chengdu, 61004 Sichuan, People's Republic of China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Gao
authors.forename: Ming
authors.initials: M
authors.lastname: Liu
authors.forename: Tao
authors.initials: T
authors.lastname: Li
authors.forename: Fuguo
authors.initials: F
authors.lastname: Huang
authors.forename: Tingting
authors.initials: T
authors.lastname: Tang
authors.forename: Zhou
authors.initials: Z
authors.lastname: Xiang
mesh_terms: D016063:Blood Loss, Surgical; D002574:Cervical Vertebrae / Q000601:surgery*; D017586:Diskectomy; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000601:surgery*; D007902:Length of Stay; D061646:Operative Time; D010147:Pain Measurement; D016059:Range of Motion, Articular; D012086:Reoperation; D013123:Spinal Fusion; D059145:Total Disc Replacement; D016896:Treatment Outcome