Dong Liang, Wang Dongqi, Chen Xiujin, Liu Tuanjing, Xu Zhengwei, Tan Mingsheng, Hao Dingjun
Department of Spine Surgery, Hong-Hui Hospital, Xi' an Jiaotong University College of Medicine, Xi'an.
Department of Spine Surgery, China-Japan Friendship Hospital, Beijing, China.
Clin Spine Surg. 2018 May;31(4):162-173. doi: 10.1097/BSD.0000000000000552.
This is a meta-analysis of controlled trials.
To assess the overall condition of adjacent segment of cervical disk arthroplasty (CDA) compared with anterior cervical discectomy and fusion (ACDF).
With the increase in CDA and ACDF, surgeons are taking more attention to adjacent segment degeneration (ASDeg) and adjacent segment disease (ASDis). There are more and more meta-analyses comparing the efficacy of CDA with ACDF, however, there are few meta-analyses referring to adjacent segment parameters, and investigators are still unable to arrive at the same conclusion.
Several important databases were searched for controlled trials comparing CDA and ACDF before February 2016 according to PRISMA guidelines. The analysis parameters included follow-up time, operative segments, cervical range of motion (ROM), adjacent segment motion, ASDeg, ASDis and adjacent segment reoperation. The risk of bias scale and Newcastle-Ottawa Scale were used to assess the papers. Subgroup analysis and sensitivity analysis were used to analyze the reason for high heterogeneity.
Forty-one controlled trials fulfilled the inclusion criteria, including 36 English papers and 5 Chinese. The average follow-up time of all included patients was 39 months. Compared with ACDF, the rate of adjacent segment reoperation in the CDA group was significantly lower (P<0.01), and the advantage of CDA group increased with the increasing of follow-up time according to subgroup analysis. The rate of ASDeg in CDA was significantly lower than that of ACDF (P<0.01). There was no statistical difference between upper and lower ASDeg using the same surgical method (P>0.05). CDA provided a greater cervical ROM than did ACDF (P<0.01). There was a lower adjacent segment ROM and the rate of ASDis in CDA compared with ACDF (P<0.05).
Compared with ACDF, the advantages of CDA were lower ASDeg, ASDis, adjacent segment reoperation and adjacent segment motion; and higher cervical ROM. However, there was no statistical difference between upper and lower adjacent segment ROM/ASDeg using the same surgery.
这是一项对对照试验的荟萃分析。
评估颈椎间盘置换术（CDA）与颈椎前路椎间盘切除融合术（ACDF）相比，相邻节段的总体情况。
随着CDA和ACDF手术量的增加，外科医生越来越关注相邻节段退变（ASDeg）和相邻节段疾病（ASDis）。越来越多的荟萃分析比较了CDA与ACDF的疗效，然而，涉及相邻节段参数的荟萃分析较少，研究人员仍无法得出相同结论。
根据PRISMA指南，检索了几个重要数据库，以查找2016年2月之前比较CDA和ACDF的对照试验。分析参数包括随访时间、手术节段、颈椎活动度（ROM）、相邻节段活动度、ASDeg、ASDis和相邻节段再次手术。使用偏倚风险量表和纽卡斯尔-渥太华量表对论文进行评估。采用亚组分析和敏感性分析来分析高异质性的原因。
41项对照试验符合纳入标准，其中包括36篇英文论文和5篇中文论文。所有纳入患者的平均随访时间为39个月。与ACDF相比，CDA组相邻节段再次手术率显著更低（P<0.01），根据亚组分析，CDA组的优势随着随访时间的延长而增加。CDA组的ASDeg发生率显著低于ACDF组（P<0.01）。采用相同手术方法时，上下节段ASDeg之间无统计学差异（P>0.05）。与ACDF相比，CDA能提供更大的颈椎ROM（P<0.01）。与ACDF相比，CDA的相邻节段ROM和ASDis发生率更低（P<0.05）。
与ACDF相比，CDA的优势在于更低的ASDeg、ASDis、相邻节段再次手术率和相邻节段活动度；以及更高的颈椎ROM。然而，采用相同手术时，上下相邻节段ROM/ASDeg之间无统计学差异。
