Radcliff Kristen, Siburn Sean, Murphy Hamadi, Woods Barrett, Qureshi Sheeraz
Department of Orthopedic Surgery, Department of Neurological Surgery, Rothman Institute, Thomas Jefferson University, 2500 English Creek Ave, Egg Harbor, NJ, 08234, USA.
Robert Wood Johnson Medical School, Rutgers University, Brunswick, NJ, USA.
Curr Rev Musculoskelet Med. 2017 Jun;10(2):170-176. doi: 10.1007/s12178-017-9399-2.
Cervical disc replacement (CDR) has emerged as a motion-preserving alternative to anterior cervical discectomy and fusion in selected cases. Despite favorable literature, CDR is not universally accepted because of concerns regarding bias in the existing literature. The purpose of this review is to identify the possible biases in the disc replacement literature.
Recent studies that compare CDR and ACDF have demonstrated equivalent or superior outcomes, lower rates of secondary surgery, and equivalent safety at medium- and long-term follow-up. In our review, we identified four types of bias that may affect the CDR literature: publication bias, external validity, confounding bias, and financial conflicts of interest. Bias, whether intentional or unintentional, can impact the interpretation and outcome of CDR studies. Recognition of this issue is critical when utilizing the existing literature to determine the efficacy of CDR and designing future studies.
在特定病例中，颈椎间盘置换术（CDR）已成为一种保留运动功能的替代前路颈椎间盘切除融合术的方法。尽管有相关文献支持，但由于对现有文献存在偏倚的担忧，CDR并未被普遍接受。本综述的目的是确定椎间盘置换文献中可能存在的偏倚。
近期比较CDR和ACDF的研究表明，在中长期随访中，两者的疗效相当或更优，二次手术率更低，安全性相当。在我们的综述中，我们确定了可能影响CDR文献的四种偏倚类型：发表偏倚、外部效度、混杂偏倚和利益冲突。偏倚，无论是有意还是无意的，都可能影响CDR研究的解释和结果。在利用现有文献确定CDR的疗效以及设计未来研究时，认识到这个问题至关重要。
