Luo Jiaquan, Wang Hongbo, Peng Jun, Deng Zhongyuan, Zhang Zhen, Liu Shixue, Wang Daidong, Gong Ming, Tang Shuo
Department of Spine Surgery, Shenzhen Baoan Shajing People's Hospital, Guangzhou Medical University, Shenzhen, P.R. China.
Department of Spine Surgery, Shenzhen Baoan Shajing People's Hospital, Guangzhou Medical University, Shenzhen, P.R. China.
World Neurosurg. 2018 May;113:225-231. doi: 10.1016/j.wneu.2018.02.113. Epub 2018 Feb 28.
The concern of adjacent segment disease (ASD) has led to the development of motion-preserving technologies, such as cervical disc arthroplasty (CDA). However, there is still controversy whether CDA is superior to anterior cervical decompression and fusion (ACDF) as to the incidence of ASD. The purpose of this study is to evaluate the rate of ASD between CDA and ACDF.
Systematic searches of all relevant studies through November 2017 were identified from the Cochrane Library, PubMed, Embase, and CNKI. Randomized controlled trials comparing the clinical effectiveness of CDA and ACDF for cervical degenerative disc disease (DDD) were included. Two independent reviewers searched and assessed all literature according to the standard of Cochrane systematic review. Data extraction and quality assessment were conducted, and RevMan 5.2 was used for data analysis. The random effects model was used if there was heterogeneity between studies; otherwise, the fixed effects model was used.
Twenty-one studies were included in our meta-analysis. The pooled data revealed that the CDA group had significantly lower adjacent segment diseases than the ACDF group did. Furthermore, there were fewer adjacent segment reoperations in the CDA group compared with the ACDF group.
In this meta-analysis, we conclude that CDA was better than the ACDF in terms of ASD and adjacent segment reoperations. This conclusion suggests that CDA is a superior alternative invention for the treatment of cervical DDD to preserve cervical range of motion and reduce the risk of ASD; however, this requires further validation and investigation in larger sample-size prospective and randomized studies with long-term follow-up.
对相邻节段疾病（ASD）的关注促使了诸如颈椎间盘置换术（CDA）等保留运动功能技术的发展。然而，关于CDA在ASD发生率方面是否优于颈椎前路减压融合术（ACDF）仍存在争议。本研究的目的是评估CDA和ACDF之间的ASD发生率。
通过系统检索Cochrane图书馆、PubMed、Embase和中国知网，确定截至2017年11月的所有相关研究。纳入比较CDA和ACDF治疗颈椎退行性椎间盘疾病（DDD）临床疗效的随机对照试验。两名独立的评价者根据Cochrane系统评价标准检索和评估所有文献。进行数据提取和质量评估，并使用RevMan 5.2进行数据分析。如果研究之间存在异质性，则使用随机效应模型；否则，使用固定效应模型。
我们的荟萃分析纳入了21项研究。汇总数据显示，CDA组的相邻节段疾病明显低于ACDF组。此外，与ACDF组相比，CDA组的相邻节段再次手术较少。
在这项荟萃分析中，我们得出结论，在ASD和相邻节段再次手术方面，CDA优于ACDF。这一结论表明，CDA是治疗颈椎DDD的一种更好的替代方法，可保留颈椎活动范围并降低ASD风险；然而，这需要在更大样本量的长期随访前瞻性随机研究中进一步验证和研究。
