Effectiveness of various anterior noncontiguous cervical spine surgeries for treatment of noncontiguous cervical degenerative disk disease: a network meta-analysis.

Abstract

We conducted a systematic review and network meta-analysis (NMA) to compare the effectiveness of noncontiguous anterior cervical surgical techniques for noncontiguous cervical degenerative disk disease (CDDD) in terms of clinical outcomes. There is a lack of consensus regarding optimal surgical management of noncontiguous CDDD. This NMA compared the clinical effectiveness of various anterior cervical surgical techniques to guide decision-making and improve patient outcomes. PubMed, CINAHL, Scopus, and Web of Science were searched through October 10, 2024, for studies comparing noncontiguous anterior surgeries for noncontiguous CDDD. Mean differences (MD) and relative risks (RR) with corresponding 95% confidence intervals (CI) were calculated using random-effects NMA models. Of the 504 articles retrieved, five cohort studies and one randomized trial were included. Patients (n=312; mean age, 51.8 years) underwent anterior cervical discectomy and fusion (ACDF) with plate fixation (n=76), ACDF with zero-profile spacer (n=95), cervical disk arthroplasty (CDA; n=45), fusion-mobility hybrid cervical surgery (HCS; n=64), or fusion-fusion HCS (n=32). No significant differences or clear ranking superiority were observed for Japanese Orthopedic Association or Neck Disability Index scores. Compared to noncontiguous ACDF with plate fixation, noncontiguous ACDF with spacer and noncontiguous CDA had a significantly lower risk of postoperative complications. Additionally, noncontiguous ACDF with spacer had a significantly lower risk of dysphagia, and all other comparisons had a lower risk of intermediate adjacent segment disease (ASD). There were no cases of pseudoarthrosis, and one case of reoperation. Certainty of evidence was "very low." This NMA provides very low certainty evidence of similar functional outcomes across surgical techniques for noncontiguous CDDD, but the risk of complications, intermediate segment ASD, and dysphagia may vary depending on technique. These findings highlight the need for higher-quality research to guide the selection of surgical technique for noncontiguous CDDD.