Does cervical disc arthroplasty reduce adjacent segment disease and other complications in comparison to anterior cervical discectomy and fusion? A meta-analysis of randomized controlled trials

Abstract

INTRODUCTION: To reduce the risk of adjacent segment disease and other procedure-related complications following anterior cervical discectomy and fusion (ACDF), cervical disc arthroplasty (CDA) has been advocated forone-level cervical disc disease. However, it remains unknown whether CDA decreases the occurrence of such complications. As such, the following study addressed a meta-analysis of randomized controlled trials assessing the efficacy of CDA in reducing adjacent segment disease and other complications in comparison to ACDF. METHODS: Three reviewers performed a literature search for randomized controlled trials comparing CDA to ACDF for radiculopathy and/or myelopathy for one-level cervical disc disease. Studies with 2 years or greater follow-up were selected. Adjacent segment disease, secondary surgery (i.e. revision, reoperation, instrumentation/graft removal), and adverse events were assessed and pooled for analyses. RESULTS: Three studies were included for review. Due to limitations with study design, studies presented with Level II evidence. CDA exhibited a 49% decrease risk for reoperation attributed to adjacent segment disease, but was not statistically significant (OR: 0.51; 95% CI: 0.23-1.10). Additional procedure-related complications did not statistically differ between groups (p>0.05). CONCLUSION: At two-year follow-up, CDA does not significantly reduce the risk of adjacent segment disease and other complications in comparison to ACDF. Due to the lack of blinding and relatively high withdrawal/drop-out rates among studies, robust conclusions supporting the advocacy of CDA over ACDF are not warranted at this stage. High-quality studies are needed to properly assess the true efficacy of such interventions.