Lu Hui, Peng Lihua
Department of Orthopaedics, Jiangjin Central Hospital of Chongqing Department of Orthopaedics, The People's Hospital of Bishan District, Chongqing, P.R. China.
Medicine (Baltimore). 2017 Dec;96(49):e8504. doi: 10.1097/MD.0000000000008504.
Total disc replacement (TDR) using Mobi-C cervical artificial disc might be promising to treat symptomatic degenerative disc disease. However, the results remained controversial. We conducted a systematic review and meta-analysis to compare the efficacy and safety of Mobi-C cervical artificial disc and anterior cervical discectomy and fusion (ACDF) in patients with symptomatic degenerative disc disease.
PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of Mobi-C versus ACDF on the treatment of symptomatic degenerative disc disease were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcomes were neck disability index (NDI) score, patient satisfaction, and subsequent surgical intervention. Meta-analysis was performed using the random-effect model.
Four RCTs were included in the meta-analysis. Overall, compared with ACDF surgery for symptomatic degenerative disc disease, TDR using Mobi-C was associated with a significantly increased NDI score (Std. mean difference = 0.32; 95% CI = 0.10-0.53; P = .004), patient satisfaction (odds risk [OR] = 2.75; 95% confidence interval [CI] = 1.43-5.27; P = .002), and reduced subsequent surgical intervention (OR = 0.20; 95% CI = 0.11-0.37; P < .001). Mobi-C was found to produce comparable neurological deterioration (OR = 0.77; 95% CI = 0.35-1.72; P = .53), radiographic success (OR = 1.18; 95% CI = 0.39-3.59; P = .77), and overall success (OR = 2.13; 95% CI = 0.80-5.70; P = .13) compared with ACDF treatment.
Among the 4 included RCTs, 3 articles were studying patients with 1 surgical level, and 1 article reported 2 surgical levels. When compared with ACDF surgery in symptomatic degenerative disc disease, TDR using Mobi-C cervical artificial disc resulted in a significantly improved NDI score, patient satisfaction, and reduced subsequent surgical intervention. There was no significant difference of neurological deterioration, radiographic success, and overall success between TDR using Mobi-C cervical artificial disc versus ACDF surgery. TDR using Mobi-C cervical artificial disc should be recommended for the treatment of symptomatic degenerative disc disease.
使用Mobi-C颈椎人工椎间盘进行全椎间盘置换术（TDR）可能是治疗症状性退行性椎间盘疾病的有效方法。然而，其结果仍存在争议。我们进行了一项系统评价和荟萃分析，以比较Mobi-C颈椎人工椎间盘与颈椎前路椎间盘切除融合术（ACDF）治疗症状性退行性椎间盘疾病患者的疗效和安全性。
系统检索了PubMed、EMbase、Web of science、EBSCO和Cochrane图书馆数据库。纳入评估Mobi-C与ACDF治疗症状性退行性椎间盘疾病效果的随机对照试验（RCT）。两名研究者独立检索文章、提取数据并评估纳入研究的质量。主要结局指标为颈部功能障碍指数（NDI）评分、患者满意度和后续手术干预。采用随机效应模型进行荟萃分析。
荟萃分析纳入了4项RCT。总体而言，与ACDF手术治疗症状性退行性椎间盘疾病相比，使用Mobi-C进行TDR与NDI评分显著增加（标准化均数差=0.32；95%可信区间[CI]=0.10-0.53；P=0.004）、患者满意度提高（优势比[OR]=2.75；95%可信区间[CI]=1.43-5.27；P=0.002）以及后续手术干预减少（OR=0.20；95%CI=0.11-0.37；P<0.001）相关。发现与ACDF治疗相比，Mobi-C导致的神经功能恶化（OR=0.77；95%CI=0.35-1.72；P=0.53）、影像学成功率（OR=1.18；95%CI=0.39-3.59；P=0.77）和总体成功率（OR=2.13；95%CI=0.80-5.70；P=0.13）相当。
在纳入的4项RCT中，3篇文章研究的是单手术节段患者，1篇文章报告了2个手术节段。与ACDF手术治疗症状性退行性椎间盘疾病相比，使用Mobi-C颈椎人工椎间盘进行TDR可显著改善NDI评分、提高患者满意度并减少后续手术干预。使用Mobi-C颈椎人工椎间盘进行TDR与ACDF手术在神经功能恶化、影像学成功率和总体成功率方面无显著差异。对于症状性退行性椎间盘疾病的治疗，推荐使用Mobi-C颈椎人工椎间盘进行TDR。
