Introduction: Cervical disc arthroplasty (CDA) was designed as a substitute for anterior cervical discectomy and fusion (ACDF) for the treatment of symptomatic cervical disc disease (CDD). Several researchers have compared CDA with ACDF for the treatment of symptomatic CDD; however, the findings of these studies are inconclusive. Based on the lately appearing evidence, we performed this meta-analysis to further verify the benefits and harms of CDA for the treatment of symptomatic CDD.
Methods: PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched for relevant trials. Outcomes were reported as relative risk or standardized mean difference with the corresponding 95% confidence interval. Trial sequential analysis (TSA) was applied to test the robustness of our findings and get more conservative estimation.
Results: Nineteen trials were included. The findings of this meta-analysis demonstrated better overall success, lower neck disability index (NDI) scores, better NDI success, lower neck and arm pain scores, greater 36-Item Short Form Health Survey (SF-36) Physical Component Summary (PCS) and Mental Component Summary (MCS) scores, more patient satisfaction, greater ROM at the operative level, fewer secondary surgical procedures (P < 0.05) in the CDA group compared with the ACDF group. CDA was not statistically different from ACDF in neurological success and adverse events (P > 0.05). TSA exhibited that the cumulative z-curve crossed both the conventional boundary and the trial sequential monitoring boundary for benefit and the required information size had also been reached, indicating sufficient and conclusive evidence had been ascertained.
Conclusions: For treating symptomatic CDD, CDA showed superiorities over ACDF in terms of overall success, NDI scores, NDI success, neck and arm pain scores, SF-36 PCS and MCS scores, patient satisfaction, ROM at the operative level and secondary surgical procedures. However, the outcomes of neurological success and adverse events were equivalent to the ACDF group.
Patient Care: This research can help surgeons comprehensively understand the superiority of cervical disc arthroplasty for symptomatic cervical disc disease compared with anterior cervical discectomy and fusion and select favorable surgical method for patients with symptomatic cervical disc disease.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of cervical disc arthroplasty for symptomatic cervical disc disease, 2) Discuss, in small groups, why cervical disc arthroplasty is superior to anterior cervical discectomy and fusion, 3) Identify an effective treatment for the treatment of symptomatic cervical disc disease.