Systematic review and meta-analysis of randomized controlled trials: comparison of total disk replacement with...

The authors performed a systematic review and meta-analysis to evaluate whether there is a beneficial clinical effect of total disk replacement compared with anterior cervical diskectomy and fusion for the treatment of single-level symptomatic cervical disk disease. A comprehensive literature search of multiple databases, including PubMed (1966-2011), Cochrane Controlled Trials Register (CENTRAL; issue 1, 2011), and Embase (1984-2011), was conducted to identify studies that met the inclusion criteria. Methodologic quality was assessed and relevant data were retrieved, and if appropriate, meta-analysis was performed. Eight randomized controlled trials were identified; six of the 8 reported 24-month follow-up results. At 24 months, total disk replacement was demonstrated to be more beneficial for patients compared with anterior cervical diskectomy and fusion for the following outcomes: overall success rate (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.37-2.33; P<.0001), overall reoperation rate (OR,.36; CI, .21-.61; P=0), reoperation rate for revision (OR, .12; CI, .02 to .64; P=.01), and visual analog scale neck pain scores (standard mean differences [SMD], -.48; CI, -.91 to -.05; P=.03). Other outcomes, including Neck Disability Index scores (SMD, -.02; CI, -.44 to .27; P=.67) and visual analog scale arm pain scores (SMD, -.21; CI, -.63 to .22; P=.34), demonstrated no differences between the 2 groups. For patients with single-level symptomatic cervical disk disease, total disk replacement was found to be more effective than anterior cervical diskectomy and fusion in the 2 outcomes of overall success rate and overall reoperation rate at 24 months. Long-term results also showed total disk replacement trended to be more effective than anterior cervical diskectomy and fusion in some aspects.