title: Cervical total disc replacement is superior to anterior cervical decompression and fusion: a meta-analysis of prospective randomized controlled trials.
abstract: BACKGROUND
  Despite being considered the standard surgical procedure for symptomatic cervical disc disease, anterior cervical decompression and fusion invariably accelerates adjacent segment degeneration. Cervical total disc replacement is a motion-preserving procedure developed as a substitute to fusion. Whether cervical total disc replacement is superior to fusion remains unclear.
  
  
  METHODS
  We comprehensively searched PubMed, EMBASE, Medline, and the Cochrane Library in accordance with the inclusion criteria to identify possible studies. The retrieved results were last updated on December 12, 2014. We classified the studies as short-term and midterm follow-up.
  
  
  RESULTS
  Nineteen randomized controlled trials involving 4516 cases were identified. Compared with anterior cervical decompression and fusion, cervical total disc replacement had better functional outcomes (neck disability index [NDI], NDI success, neurological success, neck pain scores reported on a numerical rating scale [NRS], visual analog scales scores and overall success), greater segmental motion at the index level, fewer adverse events and fewer secondary surgical procedures at the index and adjacent levels in short-term follow-up (P < 0.05). With midterm follow-up, the cervical total disc replacement group indicated superiority in the NDI, neurological success, pain assessment (NRS), and secondary surgical procedures at the index level (P < 0.05). The Short Form 36 (SF-36) and segmental motion at the adjacent level in the short-term follow-up showed no significant difference between the two procedures, as did the secondary surgical procedure rates at the adjacent level with midterm follow-up (P > 0.05).
  
  
  CONCLUSIONS
  Cervical total disc replacement presented favorable functional outcomes, fewer adverse events, and fewer secondary surgical procedures. The efficacy and safety of cervical total disc replacement are superior to those of fusion. Longer-term, multicenter studies are required for a better evaluation of the long-term efficacy and safety of the two procedures.
authors.affiliation: Department of Orthopedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jie Fang Road, Hangzhou, 310009, Zhejiang, People's Republic of China.
authors.forename: Yujie
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Orthopedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jie Fang Road, Hangzhou, 310009, Zhejiang, People's Republic of China.
authors.forename: Chengzhen
authors.initials: C
authors.lastname: Liang
authors.affiliation: Department of Orthopedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jie Fang Road, Hangzhou, 310009, Zhejiang, People's Republic of China.
authors.forename: Yiqing
authors.initials: Y
authors.lastname: Tao
authors.affiliation: Department of Orthopedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jie Fang Road, Hangzhou, 310009, Zhejiang, People's Republic of China.
authors.forename: Xiaopeng
authors.initials: X
authors.lastname: Zhou
authors.affiliation: Department of Orthopedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jie Fang Road, Hangzhou, 310009, Zhejiang, People's Republic of China.
authors.forename: Hao
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Orthopedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jie Fang Road, Hangzhou, 310009, Zhejiang, People's Republic of China.
authors.forename: Fangcai
authors.initials: F
authors.lastname: Li
authors.affiliation: Department of Orthopedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jie Fang Road, Hangzhou, 310009, Zhejiang, People's Republic of China.
authors.forename: Qixin
authors.initials: Q
authors.lastname: Chen
mesh_terms: D002574:Cervical Vertebrae / Q000601:surgery*; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000175:diagnosis / Q000601:surgery*; D007405:Intervertebral Disc Displacement / Q000175:diagnosis / Q000601:surgery*; D019547:Neck Pain / Q000209:etiology; D016017:Odds Ratio; D010147:Pain Measurement; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D016059:Range of Motion, Articular; D019233:Retreatment; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods; D059145:Total Disc Replacement / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome
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