title: Comparison of Total Disc Replacement with lumbar fusion: a meta-analysis of randomized controlled trials.
abstract: A meta-analysis was performed to evaluate whether a beneficial clinical effect of the Total Disc Replacement (TDR) over lumbar fusion for the treatment of patients with Degenerative Disc Disease (DDD). An electronic search of PubMed, Cochrane Central Register of Controlled Trials, and EMBASE from their inception to 2012 was completed, and we assessed risk bias and retrieved relevant data, and meta-analysis was performed, if appropriate. Oswestry Disability Index (ODI), Visual Analog Score (VAS), patient satisfaction or VAS patient satisfaction, narcotic use, overall success rate, reoperation rate, work status, "surgery again?", complications and radiographic outcomes were evaluated. Six RCTs were included in this meta-analysis. At 2 years, TDR was demonstrated to be more beneficial for patients compared to lumbar fusion in the following outcomes, including ODI scores (MD:-4.87, 95% CI: -7.77 to -1.97, p=0.001), patient satisfaction (OR:1.91, 95% CI: 1.27 to 2.86, p=0.002) and VAS patient satisfaction (MD:9.10, 95% CI: 3.20 to 14.99, p=0.002), the percentage of using narcotics (OR=0.54, 95%CI: 0.31 to 0.96, p=0.03), overall success rate (OR:1.68, 95% CI: 1.26 to 2.25, p=0.005), the rate of patients to chose the same surgical treatment again (OR:2.38, 95% CI: 1.72 to 3.28, p < 0.001), and complications (OR=0.50, 95%CI: 0.29 to 0.84, p=0.008). Other outcomes, including re-operation rate (OR:0.62, 95% CI: 0.36 to 1.06, p=0.08) and work status (OR=1.05, 95% CI: 0.75 to 1.47, p=0.80), were demonstrated to be no differences between the two groups. In a long-term of follow-up (2 years), TDR shows a significant superiority for the treatment of lumbar DDD compared with fusion.
authors.affiliation: Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors.forename: Hongfei
authors.initials: H
authors.lastname: Nie
authors.affiliation: Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors.forename: Guo
authors.initials: G
authors.lastname: Chen
authors.affiliation: Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors.forename: Xiandi
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors.forename: Jiancheng
authors.initials: J
authors.lastname: Zeng
mesh_terms: D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D059145:Total Disc Replacement; D016896:Treatment Outcome