Randomized controlled trials comparing cervical disc arthroplasty and anterior cervical discectomy and fusion outcomes in degenerative spine disease: a systematic review and meta-analysis.

IF 3.1 2区 医学 Q2 CLINICAL NEUROLOGY
Salim Yakdan, Braeden Benedict, Kathleen Botterbush, Adhya Lagisetty, Muhammad Irfan Kaleem, Rachel Alessio, Angela Hardi, Saad Javeed, Miguel A Ruiz-Cardozo, Alexander T Yahanda, Jing Wang, Mohamad Bydon, Wilson Z Ray, Jacob K Greenberg
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引用次数: 0

Abstract

Objective: Anterior cervical discectomy and fusion (ACDF) is an established treatment for cervical degenerative disc disease; however, the procedure can cause loss of cervical spine range of motion and potentially accelerate adjacent segment degeneration. Cervical disc arthroplasty (CDA) seeks to preserve native motion of the cervical spine, which can theoretically reduce the incidence of adjacent level degeneration. The literature regarding the relative efficacy of ACDF versus CDA remains inconsistent. In this study, the authors investigate the difference in outcomes between ACDF and CDA and identify factors contributing to the heterogeneity in the literature.

Methods: The Ovid, Embase, Scopus, Cochrane, and ClinicalTrials.gov databases were systematically searched from inception to September 5, 2023, for randomized controlled trials (RCTs) comparing ACDF and CDA for degenerative disc disease. Studies were extracted by two authors and verified by a third. Random-effects meta-analysis was performed. The primary outcome was the difference in clinical outcomes between the two surgical groups. The secondary outcomes were the differences in radiological outcomes, surgical characteristics, complication rates, and hospital lengths of stay. The study was registered with the International Prospective Register of Systematic Reviews (PROSPERO; registration no. CRD42023469204) and adhered to the PRISMA guidelines.

Results: From 584 articles uploaded to the Covidence platform for screening, 35 studies derived from 25 RCTs were included in this systematic review and meta-analysis. A total of 4530 patients were treated with ACDF (2081) and CDA (2449). Forty-six percent of the patients (2063) were male, and the mean age of the study cohort was 45 ± 3 years. In terms of the primary outcome, CDA showed higher rates of neurological and overall success. Regarding the secondary outcomes, CDA demonstrated a significantly lower rate of adjacent level disease, higher rate of heterotopic ossification, and greater range of motion at the operated level. Additionally, CDA had lower rates of reoperation but significantly longer operative times than ACDF. The inclusion of myelopathic patients and variations in follow-up between the surgical groups contributed to the observed effect heterogeneity among studies.

Conclusions: In this study, CDA showed comparable or potentially greater success in overall and neurological outcomes, along with a lower incidence of adjacent level degeneration and reoperation rates but longer operative times.

比较颈椎椎间盘置换术、前路颈椎椎间盘切除术和融合治疗退行性脊柱疾病结果的随机对照试验:系统回顾和荟萃分析。
目的:颈前路椎间盘切除术融合术(ACDF)是治疗颈椎病退行性椎间盘病的常用方法;然而,该手术会导致颈椎活动范围的丧失,并可能加速邻近节段的退变。颈椎椎间盘置换术(CDA)旨在保持颈椎的自然运动,理论上可以减少相邻节段退变的发生率。关于ACDF与CDA的相对疗效的文献仍然不一致。在这项研究中,作者调查了ACDF和CDA之间结果的差异,并确定了文献中导致异质性的因素。方法:系统检索Ovid、Embase、Scopus、Cochrane和ClinicalTrials.gov数据库,从建立到2023年9月5日,比较ACDF和CDA治疗退行性椎间盘疾病的随机对照试验(RCTs)。研究由两位作者提取,并由第三位作者验证。进行随机效应荟萃分析。主要结果是两个手术组的临床结果的差异。次要结果是放射学结果、手术特征、并发症发生率和住院时间的差异。该研究已在国际前瞻性系统评价登记册(PROSPERO)注册,注册号为:CRD42023469204),并遵守PRISMA指南。结果:从上传到covid平台进行筛选的584篇文章中,来自25项随机对照试验的35项研究被纳入本系统评价和荟萃分析。共4530例患者接受ACDF(2081例)和CDA(2449例)治疗。46%的患者(2063例)为男性,研究队列的平均年龄为45±3岁。在主要结果方面,CDA显示出更高的神经学和整体成功率。关于次要结果,CDA显示相邻节段疾病发生率明显降低,异位骨化率较高,手术节段活动范围更大。此外,CDA的再手术率较ACDF低,但手术时间明显长于ACDF。脊髓病患者的纳入和手术组之间随访的差异导致了研究中观察到的效果异质性。结论:在本研究中,CDA在整体和神经预后方面显示出相当或潜在的更大成功,同时邻近节段退变发生率和再手术率较低,但手术时间较长。
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来源期刊
Journal of neurosurgery. Spine
Journal of neurosurgery. Spine 医学-临床神经学
CiteScore
5.10
自引率
10.70%
发文量
396
审稿时长
6 months
期刊介绍: Primarily publish original works in neurosurgery but also include studies in clinical neurophysiology, organic neurology, ophthalmology, radiology, pathology, and molecular biology.
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