Chen Chiu-Ming, Yang Jui-Jung, Wu Chia-Chun
Department of Orthopaedics, Tri-Service General Hospital, National Defense Medical Center, Taipei City 11490, Taiwan.
J Clin Med. 2024 May 29;13(11):3203. doi: 10.3390/jcm13113203.
: Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are both considered to be efficacious surgical procedures for treating cervical spondylosis in patients with or without compression myelopathy. This updated systematic review and meta-analysis aimed to compare the outcomes of these procedures for the treatment of cervical degenerative disc disease (DDD) at two contiguous levels. : The PubMed, EMBASE, and Cochrane CENTRAL databases were searched up to 1 May 2023. Studies comparing the outcomes between CDA and ACDF in patients with two-level cervical DDD were eligible for inclusion. Primary outcomes were surgical success rates and secondary surgery rates. Secondary outcomes were scores on the Neck Disability Index (NDI) and Visual Analogue Scale (VAS) for neck and arm pain, as well as the Japanese Orthopaedic Association (JOA) score for the severity of cervical compression myelopathy and complication rates. : In total, eight studies (two RCTs, four retrospective studies, and two prospective studies) with a total of 1155 patients (CDA: 598; ACDF: 557) were included. Pooled results revealed that CDA was associated with a significantly higher overall success rate (OR, 2.710, 95% CI: 1.949-3.770) and lower secondary surgery rate (OR, 0.254, 95% CI: 0.169-0.382) compared to ACDF. In addition, complication rates were significantly lower in the CDA group than in the ACDF group (OR, 0.548, 95% CI: 0.326 to 0.919). CDA was also associated with significantly greater improvements in neck pain VAS than ACDF. No significant differences were found in improvements in the arm VAS, NDI, and JOA scores between the two procedures. : CDA may provide better postoperative outcomes for surgical success, secondary surgery, pain reduction, and postoperative complications than ACDF for treating patients with two-level cervical DDD.
颈椎前路椎间盘切除融合术（ACDF）和颈椎间盘置换术（CDA）都被认为是治疗伴有或不伴有脊髓型颈椎病患者颈椎病的有效手术方法。这项更新的系统评价和荟萃分析旨在比较这两种手术治疗两个连续节段颈椎退行性椎间盘疾病（DDD）的疗效。
检索了截至2023年5月1日的PubMed、EMBASE和Cochrane CENTRAL数据库。比较CDA和ACDF治疗两节段颈椎DDD患者疗效的研究符合纳入标准。主要结局是手术成功率和二次手术率。次要结局是颈部残疾指数（NDI）和颈部及手臂疼痛视觉模拟量表（VAS）评分，以及日本骨科协会（JOA）颈椎脊髓型颈椎病严重程度评分和并发症发生率。
总共纳入了8项研究（2项随机对照试验、4项回顾性研究和2项前瞻性研究），共1155例患者（CDA组598例；ACDF组557例）。汇总结果显示，与ACDF相比，CDA的总体成功率显著更高（OR = 2.710，95%CI：1.949 - 3.770），二次手术率更低（OR = 0.254，95%CI：0.169 - 0.382）。此外，CDA组的并发症发生率显著低于ACDF组（OR = 0.548，95%CI：0.326至0.919）。与ACDF相比，CDA还与颈部疼痛VAS的改善显著更大相关。两种手术在手臂VAS、NDI和JOA评分的改善方面未发现显著差异。
对于治疗两节段颈椎DDD患者，与ACDF相比，CDA在手术成功率、二次手术、疼痛减轻和术后并发症方面可能提供更好的术后疗效。
