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Rate of Adjacent Segment Disease in Cervical Disc Arthroplasty Versus Single-Level Fusion: Meta-analysis of Prospective Studies

Verma, Kushagra MD, MS*; Gandhi, Sapan D. BS; Maltenfort, Mitchell PhD*; Albert, Todd J. MD*; Hilibrand, Alan S. MD*; Vaccaro, Alexander R. MD, PhD*; Radcliff, Kristin E. MD*

doi: 10.1097/BRS.0000000000000052
Cervical Spine

Study Design. Meta-analysis of randomized controlled trials.

Objective. To compare the reported incidence of adjacent segment disease (ASD) requiring surgical intervention between anterior cervical decompression and fusion (ACDF) and total disc arthroplasty (TDA).

Summary of Background Data. The concern for ASD has led to the development of motion-preserving technologies such as TDA. To date, however, no known study has sought to compare the incidence of ASD between ACDF and TDA in major prospective studies.

Methods. A systematic review of IDE and non-IDE trials was performed using PubMed and Cochrane libraries. These databases were thoroughly searched for prospective randomized studies comparing ACDF and TDR. Six studies met the inclusion criteria for a meta-analysis and were used to report an overall rate of ASD for both ACDF and TDA.

Results. Pooling data from 6 prospective studies, the overall sample size at baseline was 1586 (ACDF = 777, TDA = 809) and at the final follow-up was 1110 giving an overall follow-up of 70%. Patients after an ACDF had a lower rate of follow-up overall than those after TDR (ACDF: 67.3% vs. TDR: 72.6%, P= 0.01). Thirty-six patients required adjacent-level surgery after an ACDF at 2 to 5 years of follow-up (6.9%) compared with 30 patients after a TDA (5.1%). The corresponding reoperation rate for ASD was 2.4 ± 1.7% per year for ACDF versus 1.1 ± 1.5% per year for TDR. These differences were not statistically significant (P= 0.44). Using a Kaplan-Meier analysis and historical data, we expect 48 patients in the ACDF group and 55 patients in the TDR group to have symptomatic disease at an adjacent level.

Conclusion. From a meta-analysis of prospective studies, there is no difference in the rate of ASD for ACDF versus TDA. We also report an overall lower rate of follow-up for patients with ACDF than for those with TDR. Future prospective studies should continue to focus on excellent patient follow-up and accurate assessment of patient symptoms that are attributable to an adjacent level as this has been an under-reported finding in prospective studies.

Level of Evidence: 1

The concern for adjacent segment disease (ASD) has led to the development of motion-preserving technologies such as total disc arthroplasty (TDA). A systematic review of IDE and non-IDE trials was performed using PubMed and Cochrane libraries. From a meta-analysis of prospective studies, there is no difference in the rate of ASD for anterior cervical decompression and fusion versus TDA.

*Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA; and

Drexel University College of Medicine, Philadelphia, PA.

Address correspondence and reprint requests to Kushagra Verma, MD, MS, 925 Chestnut St, 5th Flr, Philadelphia, PA 19107; E-mail: vermak01@gmail.com

Acknowledgment date: May 29, 2013. First revision date: August 18, 2013. Acceptance date: September 16, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, consultancy, grants/grants pending, royalties, stock/stock options, and travel/accommodations/meeting expenses.

© 2013 by Lippincott Williams & Wilkins