Comparison of multilevel cervical disc replacement and multilevel anterior discectomy and fusion: a systematic review of biomechanical and clinical evidence.

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Comparison of multilevel cervical disc replacement and multilevel anterior discectomy and fusion: a systematic review of biomechanical and clinical evidence.

World Neurosurg. 2018 May 10;:

Authors: Li Y, Shen H, Khan KZ, Fang S, Liao Z, Liu W

Abstract
The present study aimed to comprehensively compare the clinical and biomechanical efficiency of combined anterior cervical discectomy and fusion (ACDF) with the anterior cervical disc replacement (ACDR) for treatment of multilevel cervical disc diease (CDD) using a meta-analysis and systematical review. A literature search was performed using Pubmed, MEDLINE, EMBASE and the Cochrane Library for papers published between January 1960 and December 2017. Both clinical and biomechanical parameters were analyzed. Statistical tests were conducted by Revman 5.3. Nineteen studies including ten clinical studies and nine biomechanical studies were finally filtered out. As for clinical efficiency, the pooled results showed that no significant difference was observed in blood loss [P=0.09; MD 7.38 (-1.16, 15.91)], hospital stay [P=0.33, MD -0.25 (-0.76, 0.26)], JOA scores[P=0.63; MD -0.11 (-0.57, 0.34)], VAS [P=0.08; MD -0.50 (-1.06, 0.05)], NDI [P=0.33; MD -0.55 (-1.65, 0.56)] between two group. Compared with ACDF, ACDR did show increased surgical time [P=0.03; MD 31.42 (2.71, 60.14)]. On the other hand, ACDR demonstrated increased index ROM [P<0.00001; MD 13.83 (9.28, 18.39)], lower rates of adjacent segment disease (ASD) [P=0.001; OR 0.27 (0.13, 0.59)], complications [P=0.006; OR 0.62 (0.45, 0.87)], and rate of subsequent surgery [P<0.00001; OR 0.25(0.14, 0.44)]. As for biomechanical performance, ACDR could maintain index ROM and avoid compensation in adjacent ROM and tissue pressure. In conclusion, multilevel ACDR may be an effective and safe alternative to ACDF in terms of clinical and biomechanical performance. However, further multicenter and prospective studies should be conducted to obtain a stronger and reliable conclusion.

PMID: 29753897 [PubMed - as supplied by publisher]

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