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Arthroplasty Versus Fusion in Single-Level Cervical Degenerative Disc Disease: A Cochrane Review

Boselie, Toon F. M. MD*; Willems, Paul C. MD, PhD; van Mameren, Henk MD, PhD; de Bie, Rob A. MSc, PhD; Benzel, Edward C. MD, PhD§; van Santbrink, Henk MD, PhD*

Spine:
doi: 10.1097/BRS.0b013e3182994a32
Cochrane Collaboration
Abstract

Study Design. A systematic review of randomized controlled trials (RCTs).

Objective. To assess the effects of arthroplasty versus fusion in the treatment of radiculopathy or myelopathy, or both, due to single-level cervical degenerative disc disease.

Summary of Background Data. There is ongoing debate about whether fusion or arthroplasty is superior in the treatment of single-level cervical degenerative disc disease. Mainly because the intended advantage of arthroplasty compared with fusion, prevention of symptoms due to adjacent segment degeneration in the long term, is not confirmed yet. Until sufficient long-term results become available, it is important to know whether results of 1 of the 2 treatments are superior to the other in the first 1 to 2 years.

Methods. We searched electronic databases for randomized controlled trials. We included randomized controlled trials that directly compared any type of cervical fusion with any type of cervical arthroplasty, with at least 1 year of follow-up. Study selection was performed independently by 3 review authors, and “risk of bias” assessment and data extraction were independently performed by 2 review authors. In case of missing data, we contacted the study authors or the study sponsor. We assessed the quality of evidence.

Results. Nine studies (2400 participants) were included in this review; 5 of these studies had a low risk of bias. Results for the arthroplasty group were better than the fusion group for all primary comparisons, often statistically significant. For none of the primary outcomes was a clinically relevant difference in effect size shown. Quality of the evidence was low to moderate.

Conclusion. There is low to moderate quality evidence that results are consistently in favor of arthroplasty, often statistically significant. However, differences in effect size were invariably small and not clinically relevant for all primary outcomes.

Level of Evidence: 1

In Brief

Systematic review to assess arthroplasty versus fusion in the treatment of single-level cervical degenerative disc disease. There is low to moderate quality evidence that results are consistently, often significantly, in favor of arthroplasty. However, differences in effect size were invariably small and not clinically relevant for all primary outcomes.

Author Information

*Department of Neurosurgery, and

Department of Orthopaedic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands

Department of Epidemiology, Maastricht University, CAPHRI School for Public Health and Primary Care, Maastricht, the Netherlands; and

§Department of Neurosurgery, Cleveland Clinic, Cleveland, OH.

Address correspondence and reprint requests to Toon Boselie, MD, Maastricht University Medical Center, Department of Neurosurgery, CAPHRI School for Public Health and Primary Care, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands; E-mail: T.Boselie@MUMC.nl

Acknowledgment date: April 11, 2013. Acceptance date: April 15, 2013.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work.

Relevant financial activities outside the submitted work: payment for lectures, board membership, consultancy, grants, royalties, stocks.

© 2013 by Lippincott Williams & Wilkins