Effectiveness and Safety of Cervical Total Disc Replacement for Single Symptomatic Single-Level Cervical Degenerative Disc Disease: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

JIANG Hua ,  XIAO Zengming , ZHAN Xinli , LI Shide , LAO Shan , LI Shuzhen

Department of Orthopedic and Spinal Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China;

Corresponding author：

XIAO Zengming, Email: jhgl007@163.com

Keywords：

Fusion; Cervical; Disc replacement; Arthroplasty; Meta-analysis; Systematic review

DOI：

10.7507/1672-2531.20100526

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate differences of clinical effects between cervical total disc replacement (TDR) and anterior cervical discectomy and fusion (ACDF) for single symptomatic single-level cervical degenerative disc disease.
Methods Randomized controlled trials (RCTs) from the Cochrane Library Central Register of Controlled Trials (Issue 1, 2009), MEDLINE (2000 to May 2009), EMbase (2000 to May 2009), Ovid (2000 to May 2009), CBM (2000 to May 2009) and CNKI (2000 to May 2009) were electronically searched. Additionally, six relevant journals were handsearched to identify RCTs about comparison of TDR and ACDF in the treatment of single-level cervical degenerative disc disease. All RCTs demonstrating these issues were included. RevMan 5.0 software was used for meta-analyses.
Results Six RCTs involving 1 340 patients were included. The results of meta-analyses indicated that there were significant differences between the two groups in neurological success (RR=1.06, 95%CI 1.02 to 1.11, P=0.003), secondary surgical procedures (RR=0.30, 95%CI 0.17 to 0.53, P lt;0.0001) and overall success (RR=1.13, 95%CI 1.06 to 1.22, P=0.0006). However, there were no significant differences in Neck Disability Index (NDI) scores (WMD=1.53, 95%CI –0.55 to 3.61, P=0.15), neck pain scores (WMD= –2.87, 95%CI 7.75 to 1.81, P=0.23), arm pain scores (WMD= –0.7, 95%CI –0.86 to –0.54, P=0.48), radiography success (RR=0.96, 95%CI 0.92 to 1.01, P=0.11), and postoperative complications (RR=0.79, 95%CI 0.49 to 1.28, P=0.34) between the two groups.
Conclusion The evidence indicates that compared with ACDF, TDR could improve neurological status, reduce secondary surgical procedures and promote overall success for single-level cervical degenerative disc disease, but there are no significant differences in postoperative NDI, neck and arm pain scores, radiography success, and complications.

Citation： JIANG Hua,XIAO Zengming,ZHAN Xinli,LI Shide,LAO Shan,LI Shuzhen. Effectiveness and Safety of Cervical Total Disc Replacement for Single Symptomatic Single-Level Cervical Degenerative Disc Disease: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2010, 10(8): 957-963. doi: 10.7507/1672-2531.20100526 Copy

1.	Yue WM, Brodner W, Highland TR. Long-term results after anterior cervical discectomy and fusion with allograft and plating: a 5- to 11-year radiologic and clinical follow-up study. Spine, 2005, 30(19): 2138-2144.
2.	Fraser JF, Hartl R. Anterior approaches to fusion of the cervical spine:a meta-analysis of fusion rates. J Neurosurg Spine, 2007, 6(4): 298-303.
3.	Hilibrand AS, Carlson GD, Palumbo MA, et al. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am, 1999, 81(4): 519-528.
4.	Goffin J, Geusens E, Vantomme N, et al. Long-term follow-up after interbody fusion of the cervical pine. J Spinal Disord Tech, 2004, 17(2): 79-85.
5.	Park DK, An HS. Problems related to cervical fusion: malalignment and nonunion. Instr Course Lect, 2009, 58: 737-745.
6.	Sasso RC, Smucker JD, Hacker RJ, et al. Artificial disc versus fusion: a prospective, randomized study with 2-year follow-up on 99 patients. Spine, 2007, 15(12): 2933-2940.
7.	Pickett GE, Sekhon LH, Sears WR, et al. Complications with cervical arthroplasty. J Neurosurg Spine, 2006, 4(2): 98-105.
8.	Anderson PA, Sasso RC, Riew KD. Update on cervical artificial disk replacement. Instr Course Lect, 2007, 56: 237-245.
9.	Yoon DH, Yi S, Shin HC, et al. Clinical and radiological results following cervical arthroplasty. Acta Neurochir (Wien), 2006, 148(9): 943-950.
10.	Mummaneni PV, Burkus JK, Haid RW, et al. Clinical and radiographic analysis of cervical disc arthroplasty compared with allograft fusion: a randomized controlled clinical trial. J Neurosurg Spine, 2007, 6(3): 198-209.
11.	Riina J, Patel A, Dietz JW, et al. Comparison of single-level cervical fusion and a metal-on-metal cervical disc replacement device. Am J Orthop, 2008, 37(4): E71-E77.
12.	Murrey D, Janssen M, Delamarter R, et al. Results of the prospective, randomized, controlled multicenter Food and Drug Administration investigational device exemption study of the ProDisc-C total disc replacement versus anterior discectomy and fusion for the treatment of 1-level symptomatic cervical disc disease. Spine J, 2009, 9(4): 275-286.
13.	Heller JG, Sasso RC, Papadopoulos SM, et al. Comparison of BRYAN cervical disc arthroplasty with anterior cervical decompression and fusion: clinical and radiographic results of a randomized, controlled, clinical trial. Spine, 2009, 34(2): 101-107.
14.	王岩, 蔡斌, 张雪松, 等. Bryan人工颈椎间盘置换治疗单节段颈椎病的前瞻性临床研究. 中华外科杂志, 2008, 46(5): 328-332.
15.	Nabhan A, Steudel WI, Nabhan A, et al. Segmental kinematics and adjacent level degeneration following disc replacement versus fusion: RCT with three years of follow-up. J Long Term Eff Med Implants, 2007, 17(3): 229-236.
16.	Higgins JPT, Green S, editors. Assessing risk of bias in includeds tudies. Cochrane Handbook for Systematic Reviews of Interventions 5.0.0 [updated February 2008; Part 2 Chapter 8. In: The Cochrane Library, Issue 3, 2008. Chichester, UK: John Wiley & Sons, Ltd.
17.	吴泰相, 刘关键. 隐蔽分组（分配隐藏）和盲法的概念、实施与报告. 中国循证医学杂志, 2007, 7(3): 222-225.
18.	Chang UK, Kim DH, Lee MC, et al. Changes in adjacent-level disc pressure and facet joint force after cervical disc arthroplasty compared with cervical discectomy and fusion. J Neurosurg Spine, 2007, 7(1): 33-39.
19.	Pickett GE, Rouleau JP, Duggal N. Kinematic analysis of the cervical spine following implantation of an artificial cervical disc. Spine, 2005, 30(17): 1949-1954.
20.	Dmitriev AE, Cunningham BW, Hu N, et al. Adjacent level intradiscal pressure and segmental kinematics following a cervical total disc arthroplasty: an invitro human cadaveric model. Spine, 2005, 30(10): 1165-1172.
21.	Rousseau MA, Cottin P, Levante S, et al. In vivo kinematics of two types of ball-and-socket cervical disc replacements in the sagittal plane: cranial versus caudal geometric center. Spine, 2008, 33(1): E6-E9.
22.	Rabin D, Pickett GE, Bisnaire L, et al. The kinematics of anterior cervical discectomy and fusion versus artificial cervical disc: a pilot study. Neurosurgery, 2007, 61(3 Suppl): 100-105, discussion 104-105.
23.	Chang UK, Kim DH, Lee MC, et al. Changes in adjacent-level discpressure and facet joint force after cervical arthroplasty compared with cervical discectomy and fusion. J Neurosurg Spine, 2007, 7(l): 33-39.

1. Yue WM, Brodner W, Highland TR. Long-term results after anterior cervical discectomy and fusion with allograft and plating: a 5- to 11-year radiologic and clinical follow-up study. Spine, 2005, 30(19): 2138-2144.
2. Fraser JF, Hartl R. Anterior approaches to fusion of the cervical spine:a meta-analysis of fusion rates. J Neurosurg Spine, 2007, 6(4): 298-303.
3. Hilibrand AS, Carlson GD, Palumbo MA, et al. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am, 1999, 81(4): 519-528.
4. Goffin J, Geusens E, Vantomme N, et al. Long-term follow-up after interbody fusion of the cervical pine. J Spinal Disord Tech, 2004, 17(2): 79-85.
5. Park DK, An HS. Problems related to cervical fusion: malalignment and nonunion. Instr Course Lect, 2009, 58: 737-745.
6. Sasso RC, Smucker JD, Hacker RJ, et al. Artificial disc versus fusion: a prospective, randomized study with 2-year follow-up on 99 patients. Spine, 2007, 15(12): 2933-2940.
7. Pickett GE, Sekhon LH, Sears WR, et al. Complications with cervical arthroplasty. J Neurosurg Spine, 2006, 4(2): 98-105.
8. Anderson PA, Sasso RC, Riew KD. Update on cervical artificial disk replacement. Instr Course Lect, 2007, 56: 237-245.
9. Yoon DH, Yi S, Shin HC, et al. Clinical and radiological results following cervical arthroplasty. Acta Neurochir (Wien), 2006, 148(9): 943-950.
10. Mummaneni PV, Burkus JK, Haid RW, et al. Clinical and radiographic analysis of cervical disc arthroplasty compared with allograft fusion: a randomized controlled clinical trial. J Neurosurg Spine, 2007, 6(3): 198-209.
11. Riina J, Patel A, Dietz JW, et al. Comparison of single-level cervical fusion and a metal-on-metal cervical disc replacement device. Am J Orthop, 2008, 37(4): E71-E77.
12. Murrey D, Janssen M, Delamarter R, et al. Results of the prospective, randomized, controlled multicenter Food and Drug Administration investigational device exemption study of the ProDisc-C total disc replacement versus anterior discectomy and fusion for the treatment of 1-level symptomatic cervical disc disease. Spine J, 2009, 9(4): 275-286.
13. Heller JG, Sasso RC, Papadopoulos SM, et al. Comparison of BRYAN cervical disc arthroplasty with anterior cervical decompression and fusion: clinical and radiographic results of a randomized, controlled, clinical trial. Spine, 2009, 34(2): 101-107.
14. 王岩, 蔡斌, 张雪松, 等. Bryan人工颈椎间盘置换治疗单节段颈椎病的前瞻性临床研究. 中华外科杂志, 2008, 46(5): 328-332.
15. Nabhan A, Steudel WI, Nabhan A, et al. Segmental kinematics and adjacent level degeneration following disc replacement versus fusion: RCT with three years of follow-up. J Long Term Eff Med Implants, 2007, 17(3): 229-236.
16. Higgins JPT, Green S, editors. Assessing risk of bias in includeds tudies. Cochrane Handbook for Systematic Reviews of Interventions 5.0.0 [updated February 2008; Part 2 Chapter 8. In: The Cochrane Library, Issue 3, 2008. Chichester, UK: John Wiley & Sons, Ltd.
17. 吴泰相, 刘关键. 隐蔽分组（分配隐藏）和盲法的概念、实施与报告. 中国循证医学杂志, 2007, 7(3): 222-225.
18. Chang UK, Kim DH, Lee MC, et al. Changes in adjacent-level disc pressure and facet joint force after cervical disc arthroplasty compared with cervical discectomy and fusion. J Neurosurg Spine, 2007, 7(1): 33-39.
19. Pickett GE, Rouleau JP, Duggal N. Kinematic analysis of the cervical spine following implantation of an artificial cervical disc. Spine, 2005, 30(17): 1949-1954.
20. Dmitriev AE, Cunningham BW, Hu N, et al. Adjacent level intradiscal pressure and segmental kinematics following a cervical total disc arthroplasty: an invitro human cadaveric model. Spine, 2005, 30(10): 1165-1172.
21. Rousseau MA, Cottin P, Levante S, et al. In vivo kinematics of two types of ball-and-socket cervical disc replacements in the sagittal plane: cranial versus caudal geometric center. Spine, 2008, 33(1): E6-E9.
22. Rabin D, Pickett GE, Bisnaire L, et al. The kinematics of anterior cervical discectomy and fusion versus artificial cervical disc: a pilot study. Neurosurgery, 2007, 61(3 Suppl): 100-105, discussion 104-105.
23. Chang UK, Kim DH, Lee MC, et al. Changes in adjacent-level discpressure and facet joint force after cervical arthroplasty compared with cervical discectomy and fusion. J Neurosurg Spine, 2007, 7(l): 33-39.

Chinese Journal of Evidence-Based Medicine

Effectiveness and Safety of Cervical Total Disc Replacement for Single Symptomatic Single-Level Cervical Degenerative Disc Disease: A Systematic Review

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