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Secondary Surgery after Cervical Disc Arthroplasty versus Fusion for Cervical Degenerative Disc Disease: A

Ru-Sen Zhu1, Shun-Li Kan1, Ze-Gang Cao1

  • 1Department of Spine Surgery, Tianjin Union Medical Center, Tianjin, China.

Orthopaedic Surgery
|August 29, 2018
PubMed

Insights

Cervical disc arthroplasty (CDA) significantly reduces the need for secondary surgeries compared to anterior cervical discectomy and fusion (ACDF). This finding suggests CDA may be a superior surgical option for cervical degenerative disc disease.

Area of Science:

  • Neurosurgery
  • Orthopedic Surgery
  • Spine Surgery

Background:

  • Anterior cervical discectomy and fusion (ACDF) is a common treatment for cervical degenerative disc disease.
  • Concerns exist regarding the long-term efficacy and potential complications of ACDF, including secondary surgeries.
  • Cervical disc arthroplasty (CDA) has emerged as an alternative surgical approach.

Purpose of the Study:

  • To compare the efficacy of cervical disc arthroplasty (CDA) versus anterior cervical discectomy and fusion (ACDF) in reducing the incidence of secondary surgeries.
  • To provide a comprehensive meta-analysis of existing studies to determine the superiority of one surgical technique over the other.

Main Methods:

  • Systematic literature search of PubMed, EMBASE, and Cochrane Library databases.
  • Meta-analysis of 21 studies involving 4208 patients.
  • Outcomes reported as relative risk (RR) with 95% confidence intervals (CI); random-effect model used for pooled data analysis.
  • Trial sequential analysis (TSA) employed to validate findings and enhance estimate reliability.

Main Results:

  • CDA demonstrated a significantly lower frequency of secondary surgery at both the index level (RR, 0.47; 95%CI, 0.36-0.63) and adjacent levels (RR, 0.48; 95%CI, 0.36-0.65) compared to ACDF.
  • Overall, CDA showed a statistically significant reduction in secondary surgeries (index and adjacent levels combined) compared to ACDF (RR, 0.49; 95%CI, 0.41-0.60).
  • Trial sequential analysis confirmed adequate and decisive evidence supporting these findings.

Conclusions:

  • Cervical disc arthroplasty (CDA) is significantly superior to anterior cervical discectomy and fusion (ACDF) in minimizing the need for subsequent surgeries.
  • CDA may represent a more advantageous surgical intervention for patients suffering from cervical degenerative disc disease, potentially reducing reoperation rates.
  • The evidence strongly supports CDA as a preferred option for reducing secondary surgery in cervical degenerative disc disease management.

Keywords:
ACDFCervical degenerative disc diseaseCervical disc arthroplastySecondary surgery

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