Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 Oct 3;13(1):244.
doi: 10.1186/s13018-018-0940-9.

Adjacent segment degeneration or disease after cervical total disc replacement: a meta-analysis of randomized controlled trials

Shuai Xu  1 , Yan Liang  1 , Zhenqi Zhu  1 , Yalong Qian  1 , Haiying Liu  2
Affiliations
Review

Adjacent segment degeneration or disease after cervical total disc replacement: a meta-analysis of randomized controlled trials

Shuai Xu et al. J Orthop Surg Res. .

Abstract

Background: Anterior cervical discectomy and fusion (ACDF) has been widely used in cervical spondylosis, but adjacent segment degeneration/disease (ASD) was inevitable. Cervical total disc replacement (TDR) could reduce the stress of adjacent segments and retard ASD in theory, but the superiority has not been determined yet. This analysis aimed that whether TDR was superior to ACDF for decreasing adjacent segment degeneration (ASDeg) and adjacent segment disease (ASDis).

Methods: A meta-analysis was performed according to the guidelines of the Cochrane Collaboration with PubMed, EMBASE, Cochrane Library and CBM (China Biological Medicine) databases. It included randomized controlled trials (RCTs) that reported ASDeg, ASDis, and reoperation on adjacent segments after TDR and ACDF. Two investigators independently selected trials, assessed methodological quality, and evaluated the quality of this meta-analysis using the grades of recommendation, assessment, development, and evaluation (GRADE) approach.

Results: Eleven studies with 2632 patients were included in the meta-analysis. The overall rate of ASD in TDR group was lower than ACDF group (OR = 0.6; 95% CI [0.38, 0.73]; P < 0.00001). Both the incidence of ASDeg and the reoperation rate were statistically lower in the TDR group than in the ACDF group (OR = 0.58, P < 0.00001; OR = 0.52, P = 0.01, respectively). Subgroup analysis was performed according to the follow-up time and trial site; the rate of ASDeg was lower in patients underwent TDR no matter the follow-up time, and TDR tended to increase the superiority across time. The rate of ASDeg was also lower with TDR both in the USA and China (P < 0.0001, P = 0.03, respectively). But the cost-effectiveness result might be prone to neither of the two surgery approaches. According to GRADE, the overall quality of this meta-analysis was moderate.

Conclusions: TDR decreased the rates of ASDeg and reoperation compared with that of ACDF, and the superiority may become more apparent over time. We cautiously and slightly suggest adopting TDR according to the GRADE but may not believe it excessively.

Keywords: ACDF; Adjacent segment degeneration; Adjacent segment disease; Meta-analysis; TDR.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

This retrospective study was approved by the Institutional Review Board (IRB) of Peking University People’s Hospital. All patients involved in the study consent to participate in the study. And the written consent (patient identifiable information and data) has been obtained from all the patients.

Consent for publication

All individual person’s data consent to publish.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Selection process for meta-analysis of the studies
Fig. 2
Fig. 2
Risk of bias summary. The review authors’ judgments about each risk of bias item for each included study: + is “yes”, − is “no”, ? is “unclear”
Fig. 3
Fig. 3
Results of the meta-analysis for the incidence of adjacent segment degeneration/disease and reoperation. M-H Mantel–Haenszel, CI confidence interval
Fig. 4
Fig. 4
Results of the meta-analysis for adjacent segment degeneration (ASDeg).M-H Mantel–Haenszel, CI confidence interval
Fig. 5
Fig. 5
Results of the meta-analysis for adjacent segment disease (ASDis). M-H Mantel–Haenszel, CI confidence interval
Fig. 6
Fig. 6
Results of the meta-analysis for reoperation for adjacent segments. M-H Mantel–Haenszel, CI confidence interval
Fig. 7
Fig. 7
Funnel plot for the occurrence of ASD
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Robinson RA, Smith GW. Anterolateral cervical disc removal and interbody fusion for cervical disc syndrome. SAS Journal. 2010;4(1):34–35. doi: 10.1016/j.esas.2010.01.003. - DOI
    1. Baba H, Furusawa N, Imura S, et al. Late radiographic findings after anterior cervical fusion for spondylotic myeloradiculopathy. Spine. 1993;18(15):2167–2173. doi: 10.1097/00007632-199311000-00004. - DOI - PubMed
    1. Wu W, Thuomas KA, Hedlund R, et al. Degenerative changes following anterior cervical discectomy and fusion evaluated by fast spin-echo MR imaging. ACTA RADIOL. 1996;37(5):614–617. doi: 10.3109/02841859609177685. - DOI - PubMed
    1. Matsunaga S, Kabayama S, Yamamoto T, et al. Strain on intervertebral discs after anterior cervical decompression and fusion. Spine (Phila Pa 1976) 1999;24(7):670–675. doi: 10.1097/00007632-199904010-00011. - DOI - PubMed
    1. Hilibrand AS, Robbins M. Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion? SPINE J. 2004, 4;(6 Suppl):190S–4S. - PubMed

MeSH terms