1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
3School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; and.
J Neurosurg Spine. 2022 Dec 16;38(3):372-381. doi: 10.3171/2022.11.SPINE22880. Print 2023 Mar 1.
OBJECTIVE: Cervical disc arthroplasty (CDA) has been recognized as a popular option for cervical radiculopathy or myelopathy caused by disc problems that require surgery. There have been prospective randomized controlled trials comparing CDA to anterior cervical discectomy and fusion (ACDF) for 1- and 2-level disc herniations. However, the indications for CDA have been extended beyond the strict criteria of these clinical trials after widespread real-world experiences in the past decade. This article provides a bibliometric analysis with a review of the literature to understand the current trends of clinical practice and research on CDA. METHODS: The PubMed database was searched using the keywords pertaining to CDA in human studies that were published before August 2022. Analyses of the bibliometrics, including the types of papers, levels of evidence, countries, and the number of disc levels involved were conducted. Moreover, a systematic review of the contents with the emphasis on the current practice of multilevel CDA and complex cervical disc problems was performed. RESULTS: A total of 957 articles published during the span of 22 years were analyzed. Nearly one-quarter of the articles (232, 24.2%) were categorized as level I evidence, and 33.0% were categorized as levels I or II. These studies clearly demonstrated the viability and effectiveness of CDA regarding clinical and radiological outcomes, including neurological improvement, maintenance, and preservation of segmental mobility with relatively low risks for several years postoperation. Also, there have been more papers published during the last decade focusing on multilevel CDA and fewer involving the comparison of ACDF. Overall, there was a clustering of CDA papers published from the US and East Asian countries. Based on substantial clinical data of CDA for 1- and 2-level disc diseases, the practice and research of CDA show a trend toward multilevel and complex disease conditions. CONCLUSIONS: CDA is an established surgical management procedure for 1- and 2-level cervical disc herniation and spondylosis. The success of motion preservation by CDA-with low rates of complications-has outscored ACDF in patients without deformity. For more than 2-level disc diseases, the surgery shows a trend toward multiple CDA or hybrid ACDF-CDA according to individual evaluation for each level of degeneration.
目的：颈椎间盘置换术（CDA）已被认为是治疗因椎间盘问题而需要手术的神经根病或颈椎病的一种流行选择。已经有前瞻性随机对照试验比较了 CDA 与前路颈椎间盘切除融合术（ACDF）治疗 1 至 2 节段椎间盘突出症。然而，在过去十年广泛的实际经验之后，CDA 的适应证已经超出了这些临床试验的严格标准。本文通过文献综述进行了文献计量分析，以了解 CDA 的临床实践和研究现状。
方法：在 2022 年 8 月之前，使用与人类研究中 CDA 相关的关键词在 PubMed 数据库中进行搜索。对文献计量学进行分析，包括论文类型、证据水平、国家和涉及的椎间盘水平数。此外，还对内容进行了系统评价，重点是多节段 CDA 和复杂颈椎间盘问题的当前实践。
结果：共分析了 22 年来发表的 957 篇文章。近四分之一的文章（232 篇，24.2%）被归类为 I 级证据，33.0%被归类为 I 级或 II 级。这些研究清楚地表明了 CDA 在临床和影像学结果方面的可行性和有效性，包括神经功能改善、维持和保留节段活动度，并且术后数年风险相对较低。此外，过去十年发表的关于多节段 CDA 的论文越来越多，而涉及 ACDF 比较的论文越来越少。总体而言，来自美国和东亚国家的 CDA 论文发表较为集中。基于 CDA 治疗 1 至 2 节段椎间盘疾病的大量临床数据，CDA 的实践和研究呈现出向多节段和复杂疾病发展的趋势。
结论：CDA 是治疗 1 至 2 节段颈椎间盘突出症和颈椎病的一种既定手术治疗方法。CDA 通过保留运动来治疗的成功——并发症发生率低——在没有畸形的患者中优于 ACDF。对于超过 2 个节段的椎间盘疾病，根据每个节段退变的个体评估，手术呈现出多个 CDA 或 ACDF-CDA 混合的趋势。
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