Comparison of the short- and long-term treatment effect of cervical disk replacement and anterior cervical disk fusion: a meta-analysis.

BACKGROUND: Anterior cervical discectomy and fusion (ACDF) has been used as a gold standard for the treatment of cervical spondylosis, but it may cause complications such as pseudarthrosis and junctional degeneration. Cervical disk arthroplasty (CDA) may help overcome such problems, but there are inconsistencies among the published literature on its effectiveness comparing with ACDF.

METHODOLOGY: We searched "PubMed" (2000.1-2013.10), "Medline" (2000.1-2013.10), "Elsevier" (2000.1-2013.10), Cochrane library (2008.1-2013.10) databases with the key words of "cervical disk arthroplasy", "CDA", "anterior cervical disk fusion", "ACDF", "cervical", "randomized controlled study", "RCT" and searched for randomized controlled trials comparing the efficacy of ACDF and CDA for the treatment of cervical spondylosis. Neck disability index (NDI), VAS arm pain score, VAS neck pain score, ROM of the adjacent level, SF36-PCS score, SF36-MCS score and patient satisfaction were calculated by Revman5.2 software.

RESULTS: From 1,400 papers found, we chose 18 randomized controlled trials and cohorts evaluating the efficacy of CDA and ACDF on symptomatic cerebral spondylosis. The total number of patients is 3,056, in which 1,576 were in the CDA group and 1,480 were in the ACDF group. The CDA group demonstrated better results than the ACDF group concerning VAS arm pain score 1, 2, 4 years after the surgery, VAS neck pain score 1, 2, 4 years after the surgery, ROM of the adjacent level 1 and 2 years after the surgery, patient satisfaction 1, 2, 4 years after the surgery, NDI scores 1, 2, 4 years after the surgery, SF36-PCS score 1 and 2 years after the surgery and SF36-MCS score at 1 and 4 years after the surgery. There are no significant differences between the groups concerning SF36-PCS score 4 years after the surgery and SF36-MCS score at 2 years after the surgery.

CONCLUSIONS: CDA can be an effective alternative method to ACDF for the treatment of cervical spondylosis.