Comparison of artificial cervical arthroplasty versus anterior cervical discectomy and fusion for one-level cervical degenerative disc disease: a meta-analysis of randomized controlled trials.

PURPOSE:

The aim of the study was to evaluate whether there is a superior clinical effect of artificial cervical arthroplasty compared with anterior cervical discectomy and fusion (ACDF) for the treatment of one-level cervical degenerative disc disease (CDDD).

METHODS:

A comprehensive literature search of multiple databases, including PubMed, ScienceDirect, Scopus, Embase, Cochrane Central Register of Controlled Trials, was conducted to identify studies that met the inclusion criteria. Methodological quality was assessed and relevant data were extracted, and if appropriate, meta-analysis was performed.

RESULTS:

Thirteen randomized controlled trials were identified. At 24 months post-operatively, total disc replacement (TDR) was demonstrated to be more beneficial for patients compared with ACDF for the following outcomes: neurological success [odds ratio (OR) 1.92; 95 % confidence interval (CI) 1.47-2.49; p < 0.00001], range of motion [mean differences (MD), 6.67; 95 % CI 4.82-8.53; p < 0.00001], secondary surgical procedures (OR 0.50; 95 % CI 0.37-0.68; p < 0.00001), and visual analogue scale neck pain scores (MD -5.99; 95 % CI -10.54 to -1.45; p = 0.001) and visual analogue scale arm pain scores (MD -3.23; 95 % CI -6.48 to 0.02; p = 0.004). Other outcomes, including length of the hospital stay (MD -0.03; 95 % CI -0.18 to 0.12; p = 0.68), blood loss (MD 6.92 mL; 95 % CI -3.09 to 16.92 mL; p = 0.18), Neck Disability Index scores (MD -1.00; 95 % CI -5.28 to 3.28; p = 0.65) and rate of adverse events [risk ratio (RR), 0.93; 95 % CI 0.76-1.15; p = 0.52] demonstrated no differences between the 2 groups. Although the TDR group had a significantly longer operation time than the ACDF group, it was not considered clinically important.

CONCLUSIONS:

For patients with one-level CDDD, TDR was found to be more superior than ACDF in terms of neurological success, secondary surgical procedures, visual analogue scale pain scores and range of motion at 24 months post-operatively. Therefore, cervical arthroplasty is a safe and effective surgical procedure for treating one-level CDDD. We suggest adopting TDR on a large scale; with failure of TDR, ACDF would be performed.