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Review
. 2022 Aug;11(3):105-112.
doi: 10.5582/irdr.2022.01080.

Anterior cervical discectomy and fusion without plate (ACDFWP) versus anterior cervical disc arthroplasty (ACDA) for cervical spondylosis: A meta-analysis and literature review

Jiajie Peng  1 , Sihan Li  2   3 , Xiangying Lin  3 , Degui Zhong  4 , Rong Zheng  3 , Minghan Huang  3 , Pengfei Li  5 , Hongmei Song  3 , Tetsuya Asakawa  6
Affiliations
Review

Anterior cervical discectomy and fusion without plate (ACDFWP) versus anterior cervical disc arthroplasty (ACDA) for cervical spondylosis: A meta-analysis and literature review

Jiajie Peng et al. Intractable Rare Dis Res. 2022 Aug.

Abstract

This meta-analysis compared the clinical outcomes between two alternative surgeries for patients with cervical spondylosis, namely anterior cervical discectomy and fusion (ACDF) without plate (ACDFWP) vs. anterior cervical disc arthroplasty (ACDA). We searched databases, including PubMed, EMBASE, Cochrane Library, Google Scholar, and Web of Science (firstly available-2019). A standard meta-analysis was performed with the included studies. A Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool was used for the evaluation of the study quality of nonrandomized-controlled trials (nRCTs), while a Risk of Bias (RoB) battery was used for randomized controlled trials (RCTs). Eight studies involving 640 patients were included. No significant difference was found in the indices of Neck Disability Index (NDI) score, Visual Analog Score (VAS), Japanese Orthopaedic Association (JOA) score, operative time, blood loss, Swallowing Quality of Life Score (SWAL-QL), and complications. Cervical alignment was significantly better in the ACDFWP than in ACDA (mean difference (MD) = -0.67, 95% confidence interval (CI) [-1.11, -0.23], P = 0.003, I 2 = 20%). Although the alternative ACDFWP was slightly superior in terms of the index of cervical alignment, the limited research on this subject present insufficient evidence. Further well-designed studies are warranted in the future.

Keywords: anterior cervical disc arthroplasty; anterior cervical discectomy and fusion without plate; cervical alignment; cervical spondylosis; meta-analysis.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Schematic diagram of the surgeries for cervical spondylosis. A. Schematic diagram of the cervical spine. B. Conventional anterior cervical discectomy and fusion (ACDF) with plate. C. Anterior cervical discectomy and fusion without plate (ACDFWP). D. Anterior cervical disc arthroplasty (ACDA). Most of previous studies compared ACDF with plate and ACDA (B vs.D), in the present study we compared ACDFWP vs. ACDA (C vs. D).
Figure 2.
Figure 2.
Flow chart of the searching strategy and selection of literature reports.
Figure 3.
Figure 3.
Quality assessment of the involved literatures with a RoB tool for RCTs (A) and a ROBINS-I tool for nRCTs (B). L = Low, UC = Unclear, H = High, M = Moderate, S = Serious, C = Critical, NI = No information.
Figure 4.
Figure 4.
Meta-analysis for the clinical assessments of ACDA and ACDFWP. A. Forest plot for the scores of NDI. B. Forest plot for the scores of VAS. C. Forest plot for the scores of JOA. D. Forest plot for the scores of cervical alignment.
Figure 5.
Figure 5.
Meta-analyses of the other outcome indices of ACDA and ACDFWP. A. Forest plot for the operative time. B. Forest plot for the scores of blood loss. C. Forest plot for the scores of SWAL-QL. D. Forest plot for the scores of complications.
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