Comparison of anterior cervical discectomy and fusion versus artificial disc replacement for cervical spondylotic myelopathy: a meta-analysis

Chao-Jui ChangDepartment of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan;
Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan;

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Yuan-Fu LiuDepartment of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan;
Department of Orthopaedics, Dou-Liou Branch of National Cheng Kung University Hospital, Yunlin;

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Yu-Meng HsiaoDepartment of Orthopedics, Tainan Municipal An-Nan Hospital, China Medical University, Tainan;

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Yi-Hung HuangDepartment of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan;
Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City;

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Keng-Chang LiuDepartment of Orthopaedic Surgery, Buddhist Dalin Tzu Chi General Hospital, Chiayi;
School of Medicine, Tzu Chi University, Hualien City;

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Ruey-Mo LinDepartment of Orthopedics, Tainan Municipal An-Nan Hospital, China Medical University, Tainan;

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Cheng-Li LinDepartment of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan;
Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan;
Musculoskeletal Research Center, Innovation Headquarters, National Cheng Kung University, Tainan; and
Medical Device Innovation Center (MDIC), National Cheng Kung University, Tainan, Taiwan

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OBJECTIVE

Anterior cervical discectomy and fusion (ACDF) has long been regarded as a gold standard in the treatment of cervical myelopathy. Subsequently, cervical artificial disc replacement (c-ADR) was developed and provides the advantage of motion preservation at the level of the intervertebral disc surgical site, which may also reduce stress at adjacent levels. The goal of this study was to compare clinical and functional outcomes in patients undergoing ACDF with those in patients undergoing c-ADR for cervical spondylotic myelopathy (CSM).

METHODS

A systematic literature review and meta-analysis were performed using the Embase, PubMed, and Cochrane Central Register of Controlled Trials databases from database inception to November 21, 2021. The authors compared Neck Disability Index (NDI), SF-36, and Japanese Orthopaedic Association (JOA) scores; complication rates; and reoperation rates for these two surgical procedures in CSM patients. The Mantel-Haenszel method and variance-weighted means were used to analyze outcomes after identifying articles that met study inclusion criteria.

RESULTS

More surgical time was consumed in the c-ADR surgery (p = 0.04). Shorter hospital stays were noted in patients who had undergone c-ADR (p = 0.04). Patients who had undergone c-ADR tended to have better NDI scores (p = 0.02) and SF-36 scores (p = 0.001). Comparable outcomes in terms of JOA scores (p = 0.24) and neurological success rate (p = 0.12) were noted after the surgery. There was no significant between-group difference in the overall complication rates (c-ADR: 18% vs ACDF: 25%, p = 0.17). However, patients in the ACDF group had a higher reoperation rate than patients in the c-ADR group (4.6% vs 1.5%, p = 0.02).

CONCLUSIONS

At the midterm follow-up after treatment of CSM, better functional outcomes as reflected by NDI and SF-36 scores were noted in the c-ADR group than those in the ACDF group. c-ADR had the advantage of retaining range of motion at the level of the intervertebral disc surgical site without causing more complications. A large sample size with long-term follow-up studies may be required to confirm these findings in the future.

ABBREVIATIONS

ACDF = anterior cervical discectomy and fusion; ADR = artificial disc replacement; ASD = adjacent-segment disease; c-ADR = cervical ADR; CSM = cervical spondylotic myelopathy; HO = heterotopic ossification; JOA = Japanese Orthopaedic Association; NDI = Neck Disability Index; ROM = range of motion.

Supplementary Materials

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Images from de Andrada Pereira et al. (pp 525–534).

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