Anterior cervical disc arthroplasty (ACDA) versus anterior cervical discectomy and fusion (ACDF): a systematic review and meta-analysis.
BACKGROUND
Surgical approaches are usually required in cases of severe cervical disc disease. The traditional method of anterior cervical disc fusion (ACDF) has been associated with reduced local mobility and increased occurrence of adjacent segment disease. The newer method of anterior cervical disc arthroplasty (ACDA) relies upon artificial discs of various products. Current literature is inconsistent in the comparative performance of these methods with regards to clinical, radiological and patient outcomes.


METHODS
Electronic databases, including OVID Medline, PubMed, Scopus, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, were comprehensively searched to retrieve studies comparing the treatment outcomes of ACDF and ACDA. Baseline characteristics and outcome data were extracted from eligible articles.


RESULTS
Two hundred and fifty five articles were identified through the database searches, and after screening 28 studies were included in the systematic review and meta-analysis. A total of 4,070 patients were included (2156 ACDA, 1914 ACDF). There was no significant difference between the two groups in operation time, blood loss during operation, long-term all-complication rate and reoperation rate at the level of injury. The ACDA group had significantly better neurological outcomes, as well as a significantly lower rate of adjacent segment diseases.


CONCLUSIONS
Compared with ACDF, the ACDA procedure is associated with improved reoperation rate and reduction in neurological deficits amongst previously demonstrated benefits. There is heterogeneity in ACDA devices; future studies are required to investigate the impact of this technique on treatment outcomes.
NeuroSpine Surgery Research Group (NSURG), Sydney, Australia;; NeuroSpine Clinic, Prince of Wales Private Hospital, Randwick, Sydney, Australia;; University of New South Wales, Sydney, Australia;
Monish M
MM
Maharaj
NeuroSpine Surgery Research Group (NSURG), Sydney, Australia;; NeuroSpine Clinic, Prince of Wales Private Hospital, Randwick, Sydney, Australia;; University of New South Wales, Sydney, Australia;
Ralph J
RJ
Mobbs
NeuroSpine Surgery Research Group (NSURG), Sydney, Australia;; NeuroSpine Clinic, Prince of Wales Private Hospital, Randwick, Sydney, Australia;; University of New South Wales, Sydney, Australia;
Jarred
J
Hogan
University of Sydney, Sydney, Australia.
Dong Fang
DF
Zhao
NeuroSpine Surgery Research Group (NSURG), Sydney, Australia;; NeuroSpine Clinic, Prince of Wales Private Hospital, Randwick, Sydney, Australia;; University of New South Wales, Sydney, Australia;
Prashanth J
PJ
Rao
NeuroSpine Surgery Research Group (NSURG), Sydney, Australia;; NeuroSpine Clinic, Prince of Wales Private Hospital, Randwick, Sydney, Australia;; University of New South Wales, Sydney, Australia;; University of Sydney, Sydney, Australia.
Kevin
K
Phan
Anterior cervical disc arthroplasty (ACDA); adjacent segment disease; anterior cervical discectomy and fusion (ACDF); meta-analysis
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