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Randomized Controlled Trial
. 2013 Jul;37(7):1315-25.
doi: 10.1007/s00264-013-1883-8. Epub 2013 May 4.

Comparison of artificial total disc replacement versus fusion for lumbar degenerative disc disease: a meta-analysis of randomized controlled trials

Jiangbo Wei  1 , Yueming Song, Lin Sun, Chaoliang Lv
Affiliations
Randomized Controlled Trial

Comparison of artificial total disc replacement versus fusion for lumbar degenerative disc disease: a meta-analysis of randomized controlled trials

Jiangbo Wei et al. Int Orthop. 2013 Jul.

Abstract

Purpose: To compare the efficacy and safety of TDR to that of the fusion for the treatment of lumbar degenerative disc disease (LDDD).

Methods: Randomized controlled trials comparing TDR with any other intervention for LDDD were acquired by a comprehensive search in PubMedCentral, MEDLINE, EMBASE, BIOSIS, ClinicalTrials.gov, and the FDA trials register. Methodologic quality was assessed and relevant data were retrieved, and appropriate meta-analysis was performed. Two review authors independently selected studies, extracted data, and assessed risk of bias. Results and upper bounds of confidence intervals were compared with predefined clinically relevant differences.

Results: Six relevant randomized controlled trials (RCTs) involving 1,603 patients were identified and reported two year follow-up results. Patients in TDR group compared with lumbar fusion group demonstrated significant improvements in ODI, VAS scores and complication rates at the two year follow-up. Meanwhile, except for operating time in anterior group, intra-operative blood loss, operating time in posterior group, and reoperation rate were without clinical significance between the two groups. In addition, the range of motion (ROM) was maintained within normal ranges after TDR.

Conclusions: The results showed the TDR has significant safety and efficacy comparable to lumbar fusion at two year follow-up. Although superiority compared to fusion could not be proved, by comparing clinical symptoms relieved, motion preserved, and the low reoperation rate during long-term follow-up on TDR, TDR was considered safe and effective. Therefore, the authors suggest adopting TDR on a large scale; with failure of TDR, interbody fusion would be performed.

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Figures

Fig. 1
Fig. 1
Flowchart showing the identification, inclusion, and exclusion of the randomized controlled trials (RCTs)
Fig. 2
Fig. 2
Results of the meta-analysis for the visual analogue scale (VAS) for TDR and fusion groups at 2-year
Fig. 3
Fig. 3
Results of the meta-analysis for the Owestry disability index (ODI) for TDR and fusion groups at 2-year
Figs. 4, 5
Figs. 4, 5
Results of the meta-analysis for intraoperative blood loss for TDR and fusion subgroups at 2-year
Figs. 6, 7
Figs. 6, 7
Results of the meta-analysis for operating time for TDR and fusion subgroups at 2-year
Fig. 8
Fig. 8
Results of the meta-analysis for proportion of full-time and part-time work for TDR and fusion groups at 2-year
Fig. 9
Fig. 9
Results of the meta-analysis for complication for TDR and fusion groups at 2-year
Fig. 10
Fig. 10
Results of the meta-analysis for reoperation rate for TDR and fusion groups at 2-year. Abbreviations: TDR, Artificial total disc replacement; CI, Confidence interval; M-H, Mantel-Haenszel; SD, standard deviation
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Comment in

References

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