title: Polyurethane on titanium unconstrained disc arthroplasty versus anterior discectomy and fusion for the treatment of cervical disc disease: a review of level I-II randomized clinical trials including clinical outcomes.
abstract: OBJECTIVE
  To contrast the clinical and radiologic outcomes and adverse events of anterior cervical discectomy and fusion (ACDF) with a single cervical disc arthroplasty design, the polyurethane on titanium unconstrained cervical disc (PTUCD).
  
  
  METHODS
  This is a systematic review of randomized clinical trials (RCT) with evidence level I-II reporting clinical outcomes. After a search on different databases including PubMed, Cochrane Central Register of Controlled Trials, and Ovid MEDLINE, a total of 10 RCTs out of 51 studies found were entered in the study. RTCs were searched from the earliest available records in 2005 to November 2014.
  
  
  RESULTS
  Out of a total of 1101 patients, 562 were randomly assigned into the PTUCD arthroplasty group and 539 into the ACDF group. The mean follow-up was 30.9 months. Patients undergoing arthroplasty had lower Neck Disability Index, and better SF-36 Physical component scores than ACDF patients. Patients with PTUCD arthroplasty had also less radiological degenerative changes at the upper adjacent level. Overall adverse events were twice more frequent in patients with ACDF. The rate of revision surgery including both adjacent and index level was slightly higher in patients with ACDF, showing no statistically significant difference.
  
  
  CONCLUSIONS
  According to this review, PTUCD arthroplasty showed a global superiority to ACDF in clinical outcomes. The impact of both surgical techniques on the cervical spine (radiological spine deterioration and/or complications) was more severe in patients undergoing ACDF. However, the rate of revision surgeries at any cervical level was equivalent for ACDF and PTUCD arthroplasty.
authors.affiliation: Institute for Research on Musculoskeletal Disorders, School of Medicine, Valencia Catholic University, Quevedo 2, 46001, Valencia, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Aragonés
authors.affiliation: Spine Surgery Unit, Hospital La Fraternidad, Paseo de la Habana 83-85, 28036, Madrid, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Hevia
authors.affiliation: Institute for Research on Musculoskeletal Disorders, School of Medicine, Valencia Catholic University, Quevedo 2, 46001, Valencia, Spain. carlos.barrios@ucv.es.
authors.forename: Carlos
authors.initials: C
authors.lastname: Barrios
mesh_terms: D000368:Aged; D001178:Arthroplasty / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D002574:Cervical Vertebrae / Q000601:surgery*; D017586:Diskectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000601:surgery; D055959:Intervertebral Disc Degeneration / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011140:Polyurethanes; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D012086:Reoperation / Q000706:statistics & numerical data; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D014025:Titanium; D016896:Treatment Outcome
chemical_list: D011140:Polyurethanes; D014025:Titanium
keywords: Adjacent segment degeneration; Anterior cervical fusion; Bryan disc; Cervical disc arthroplasty; Randomized clinical trial