Study Design. Systematic Review.
Objective. (1) To qualitatively analyze the literature on the efficacy and effectiveness of artificial cervical disc arthroplasty (ACDA). (2) To highlight methodological and reporting issues of randomized controlled trials (RCT) reports on effectiveness of ACDA compared to cervical fusion.
Summary of Background Data. ACDA is an alternate surgical procedure that may replace cervical fusion in selected patients suffering from cervical degenerative disc disease.
Methods. We searched seven electronic databases, including MEDLINE, Cochrane Library, and EMBASE, unpublished sources, and reference lists for studies on the efficacy and effectiveness of ACDA compared to cervical fusion—the surgical standard of care for patients with cervical degenerative disc disease.
Results. A total of 622 studies were retrieved, of which 18 (13 case series, four RCT reports, one nonrandomized comparative study) met the inclusion criteria for this review. The four RCTs and the nonrandomized comparative study concluded that the effectiveness of ACDA is not inferior to that of cervical fusion in the short term (up to 2-yr follow-up). The safety profile of both procedures appears similar. The case series reviewed noted improved clinical outcomes at 1 or 2 years after one or multiple-level ACDA.
Conclusion. ACDA is a surgical procedure that may replace cervical fusion in selected patients suffering from cervical degenerative disc disease. Within 2 years of follow-up, the effectiveness of ACDA appears similar to that of cervical fusion. Weak evidence exists that ACDA may be superior to fusion for treating neck and arm pain. Future studies should report change scores and change score variance in accordance with RCT guidelines, in order to strengthen credibility of conclusions and to facilitate meta-analyses of studies.
This systematic review of studies on the effectiveness of artificial cervical disc arthroplasty compared to cervical fusion concluded that artificial cervical disc arthroplasty appears to be at least as effective as cervical fusion in the short term. Further, RCTs should adhere to reporting guidelines, in order to strengthen credibility of conclusions and to facilitate meta-analyses of studies.
*Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
†Alberta Bone and Joint Health Institute
Address correspondence and reprint requests to Monica Cepoiu-Martin, MD, MSc, 3rd Floor, TRW, 3280 Hospital Drive NW, Calgary, Alberta, Canada T2N 4Z6; E-mail: Monica.firstname.lastname@example.org.
Acknowledgment date: September 28, 2010. Revised date: December 24, 2010. Accepted date: January 24, 2011.
The manuscript submitted does not contain information about medical device(s)/drug(s).
Other funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.