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Meta-Analysis
. 2012;7(8):e43407.
doi: 10.1371/journal.pone.0043407. Epub 2012 Aug 17.

Anterior cervical discectomy with arthroplasty versus arthrodesis for single-level cervical spondylosis: a systematic review and meta-analysis

Aria Fallah  1 , Elie A Akl, Shanil Ebrahim, George M Ibrahim, Alireza Mansouri, Clary J Foote, Yuqing Zhang, Michael G Fehlings
Affiliations
Meta-Analysis

Anterior cervical discectomy with arthroplasty versus arthrodesis for single-level cervical spondylosis: a systematic review and meta-analysis

Aria Fallah et al. PLoS One. 2012.

Abstract

Objective: To estimate the effectiveness of anterior cervical discectomy with arthroplasty (ACDA) compared to anterior cervical discectomy with fusion (ACDF) for patient-important outcomes for single-level cervical spondylosis.

Data sources: Electronic databases (MEDLINE, EMBASE, Cochrane Register for Randomized Controlled Trials, BIOSIS and LILACS), archives of spine meetings and bibliographies of relevant articles.

Study selection: We included RCTs of ACDF versus ACDA in adult patients with single-level cervical spondylosis reporting at least one of the following outcomes: functionality, neurological success, neck pain, arm pain, quality of life, surgery for adjacent level degeneration (ALD), reoperation and dysphonia/dysphagia. We used no language restrictions. We performed title and abstract screening and full text screening independently and in duplicate.

Data synthesis: We used random-effects model to pool data using mean difference (MD) for continuous outcomes and relative risk (RR) for dichotomous outcomes. We used GRADE to evaluate the quality of evidence for each outcome.

Results: Of 2804 citations, 9 articles reporting on 9 trials (1778 participants) were eligible. ACDA is associated with a clinically significant lower incidence of neurologic failure (RR = 0.53, 95% CI = 0.37-0.75, p = 0.0004) and improvement in the Neck pain visual analogue scale (VAS) (MD = 6.56, 95% CI = 3.22-9.90, p = 0.0001; Minimal clinically important difference (MCID) = 2.5. ACDA is associated with a statistically but not clinically significant improvement in Arm pain VAS and SF-36 physical component summary. ACDA is associated with non-statistically significant higher improvement in the Neck Disability Index Score and lower incidence of ALD requiring surgery, reoperation, and dysphagia/dysphonia.

Conclusions: There is no strong evidence to support the routine use of ACDA over ACDF in single-level cervical spondylosis. Current trials lack long-term data required to assess safety as well as surgery for ALD. We suggest that ACDA in patients with single level cervical spondylosis is an option although its benefits and indication over ACDF remain in question.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. PRISMA 2009 Flow Diagram.
Figure 2
Figure 2. Neck disabiltiy index improvement in participants undergoing ACDA vs. ACDF for single level cervical spondylosis.
CI indicates confidence interval.
Figure 3
Figure 3. Neurological success in participants undergoing ACDA vs. ACDF for single level cervical spondylosis.
CI indicates confidence interval.
Figure 4
Figure 4. Neck visual analogue scale pain score improvement in participants undergoing ACDA vs. ACDF for single level cervical spondylosis.
CI indicates confidence interval.
Figure 5
Figure 5. Arm visual analogue pain score improvement in participants undergoing ACDA vs. ACDF for single level cervical spondylosis.
CI indicates confidence interval.
Figure 6
Figure 6. SF-36 physical component summary score improvement in participants undergoing ACDA vs. ACDF for single level cervical spondylosis.
CI indicates confidence interval.
Figure 7
Figure 7. Surgery for ALD in participants undergoing ACDA vs. ACDF for single level cervical spondylosis.
CI indicates confidence interval.
Figure 8
Figure 8. Reoperation in participants undergoing ACDA vs. ACDF for single level cervical spondylosis.
CI indicates confidence interval.
Figure 9
Figure 9. Dysphonia/dysphagia in participants undergoing ACDA vs. ACDF for single level cervical spondylosis.
CI indicates confidence interval.
Figure 10
Figure 10. Cochrane risk of bias across studies.
Figure 11
Figure 11. Grade profile for ACDA vs. ACDF for single level cervical spondylosis.
See this image and copyright information in PMC

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