title: Minimum 4-year outcomes of cervical total disc arthroplasty versus fusion: a meta-analysis based on prospective randomized controlled trials.
abstract: The prevalence of cervical disc disease is high, and the traditional surgical method of anterior cervical discectomy and fusion (ACDF) carries with it the disadvantages of motion loss at the operated level, and accelerated adjacent level disc degeneration. Preliminary results of the efficacy and reoperative rate comparing TDA versus ACDF have been reported; however, the long-term outcomes of TDA versus ACDF still remain a topic of debate. This review was prepared following the standard procedures set forth by the Cochrane Collaboration organization, and preferred reporting items for systematic reviews and meta-analyses (PRISMA). The only studies included were randomized controlled trials with a minimum of 4 years of follow-up data. The meta-analysis included the neck disability index (NDI), visual analog scale (VAS) of neck and arm pain, SF-36 physical component scores (SF-36 PCS), over success, neurological success, work status, implant-related complications, and secondary surgery events. Four randomized controlled trials meet the inclusion criteria. The long-term improvement of NDI, VAS of neck and arm pain, SF-36 PCS, over success, and neurological success favored the TDA group. The TDA group also had a lower incidence of secondary surgery for both the index level (RR: 0.45 [0.28, 0.72]) and adjacent level (RR: 0.53 [0.33, 0.88]). In this meta-analysis of 4 included RCTs with a minimum 4 years of follow-ups, total disc arthroplasty showed improvements over ACDF as measured by the NDI, VAS of neck and arm pain, and SF-36 PCS.
authors.affiliation: From the Department of Spinal Surgery (A-MW, HX, H-MJ, Z-YH, Q-BL, SW, H-ZX, Y-LC), Second Affiliated Hospital of Wenzhou Medical University, Zhejiang Spinal Research Center, Wenzhou, Zhejiang, People's Republic of China; and Department of Orthopaedic Surgery (KPM), Orthopaedic Spinal Research Institute, University of Maryland St Joseph Medical Center, Towson, MD, USA.
authors.forename: Ai-Min
authors.initials: AM
authors.lastname: Wu
authors.forename: Hui
authors.initials: H
authors.lastname: Xu
authors.forename: Kenneth Paul
authors.initials: KP
authors.lastname: Mullinix
authors.forename: Hai-Ming
authors.initials: HM
authors.lastname: Jin
authors.forename: Zhe-Yu
authors.initials: ZY
authors.lastname: Huang
authors.forename: Qing-Bo
authors.initials: QB
authors.lastname: Lv
authors.forename: Sheng
authors.initials: S
authors.lastname: Wang
authors.forename: Hua-Zi
authors.initials: HZ
authors.lastname: Xu
authors.forename: Yong-Long
authors.initials: YL
authors.lastname: Chi
mesh_terms: D002574:Cervical Vertebrae; D004185:Disability Evaluation; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000601:surgery*; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D019547:Neck Pain / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D016059:Range of Motion, Articular; D013123:Spinal Fusion / Q000009:adverse effects / Q000706:statistics & numerical data*; D059145:Total Disc Replacement / Q000009:adverse effects / Q000706:statistics & numerical data*