Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT.
Clin Spine Surg. 2023 Nov 1;36(9):339-355. doi: 10.1097/BSD.0000000000001537. Epub 2023 Sep 22.
STUDY DESIGN: A meta-analysis of randomized controlled trials (RCTs). OBJECTIVE: The aim of this study was to compare mid-term to long-term outcomes of cervical disk arthroplasty (CDA) with those of anterior cervical discectomy and fusion (ACDF) for the treatment of symptomatic cervical degenerative disk disease. SUMMARY OF BACKGROUND DATA: After ACDF to treat symptomatic cervical degenerative disk disease, the loss of motion at the index level due to fusion may accelerate adjacent-level disk degeneration. CDA was developed to preserve motion and reduce the risk of adjacent segment degeneration. Early-term to mid-term clinical outcomes from RCTs suggest noninferiority of CDA compared with ACDF, but it remains unclear whether CDA yields better mid-term to long-term outcomes than ACDF. MATERIALS AND METHODS: Two independent reviewers searched PubMed, Embase, and the Cochrane Library for RCTs with at least 60 months of follow-up. The risk ratio or standardized mean difference (and 95% CIs) were calculated for dichotomous or continuous variables, respectively. RESULTS: Eighteen reports of 14 RCTs published in 2014-2023 were included. The pooled analysis demonstrated that the CDA group had a significantly greater improvement in neurological success and Neck Disability Index than the ACDF group. The ACDF group exhibited a significantly better improvement in the Short Form-36 Health Survey Physical Component Summary than the CDA group. Radiographic adjacent segment degeneration was significantly lower in the CDA group at 60- and 84-month follow-ups; at 120-month follow-up, there was no significant difference between the 2 groups. Although the overall rate of secondary surgical procedures was significantly lower in the CDA group, we did not observe any significant difference at 60-month follow-up between the CDA and ACDF group and appreciated statistically significant lower rates of radiographic adjacent segment degeneration, and symptomatic adjacent-level disease requiring surgery at 84-month and 108- to 120-month follow-up. The rate of adverse events and the neck and arm pain scores in the CDA group were not significantly different from those of the ACDF group. CONCLUSIONS: In this meta-analysis of 14 RCTs with 5- to 10-year follow-up data, CDA resulted in significantly better neurological success and Neck Disability Index scores and lower rates of radiographic adjacent segment degeneration, secondary surgical procedures, and symptomatic adjacent-level disease requiring surgery than ACDF. ACDF resulted in improved Short Form-36 Health Survey Physical Component Summary scores. However, the CDA and ACDF groups did not exhibit significant differences in overall changes in neck and arm pain scores or rates of adverse events.
研究设计：随机对照试验（RCT）的荟萃分析。
目的：本研究旨在比较颈椎间盘置换术（CDA）与前路颈椎间盘切除融合术（ACDF）治疗症状性颈椎退行性椎间盘疾病的中期至长期结果。
背景资料概要：在 ACDF 治疗症状性颈椎退行性椎间盘疾病后，由于融合导致索引水平的运动丧失可能会加速相邻节段的椎间盘退化。CDA 的开发旨在保留运动并降低相邻节段退化的风险。来自 RCT 的早期至中期临床结果表明 CDA 与 ACDF 相比非劣效，但尚不清楚 CDA 是否比 ACDF 产生更好的中期至长期结果。
材料和方法：两名独立审查员搜索了 PubMed、Embase 和 Cochrane 图书馆，以查找至少有 60 个月随访的 RCT。分别为二分类或连续性变量计算风险比或标准化均数差（和 95%置信区间）。
结果：2014 年至 2023 年发表的 14 项 RCT 的 18 份报告被纳入。荟萃分析表明，CDA 组在神经功能成功和颈部残疾指数方面的改善明显大于 ACDF 组。ACDF 组在短期 36 健康调查身体成分综合评分方面的改善明显优于 CDA 组。在 60 个月和 84 个月的随访中，CDA 组的放射学相邻节段退变明显较低；在 120 个月的随访中，两组之间没有显著差异。虽然 CDA 组的二次手术总发生率明显较低，但我们在 60 个月的随访中没有观察到 CDA 和 ACDF 组之间的任何显著差异，并且在 84 个月和 108 至 120 个月的随访中观察到放射学相邻节段退行性变、需要手术的症状性邻近水平疾病的发生率显著降低。CDA 组的不良事件发生率和颈部和手臂疼痛评分与 ACDF 组无显著差异。
结论：在这项包含 14 项 RCT 的荟萃分析中，有 5 至 10 年的随访数据，CDA 导致神经功能成功和颈部残疾指数评分显著改善，放射学相邻节段退行性变、二次手术和需要手术的症状性邻近水平疾病的发生率显著降低，而 ACDF 则改善了短期 36 健康调查身体成分综合评分。然而，CDA 和 ACDF 组在颈部和手臂疼痛评分的总体变化或不良事件发生率方面没有表现出显著差异。
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