Cervical artificial disc replacement associated with better functional outcomes than ACDF for patients with single-level cervical spondylotic myelopathy

Cheng-Li Lin

Cervical artificial disc replacement (c-ADR) provides better functional outcomes than anterior cervical discectomy and fusion (ACDF) in patients with single-level cervical spondylotic myelopathy (CSM), a recent meta-analysis has shown.

The research, published by Cheng-Li Lin (National Cheng Kung University Hospital, Tainan City, Taiwan) et al in the Journal of Neurosurgery: Spine, highlighted that c-ADR had the advantage of retaining range of motion at the level of the intervertebral disc surgical site without causing more complications.

However, the study authors note that “a large sample size with long-term follow-up studies may be required to confirm these findings in the future”.

The aim of the study was to compare clinical and functional outcomes in patients undergoing ACDF with those in patients undergoing c-ADR for single-level CSM.

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), 36-Item short form survey (SF-36), and Japanese Orthopaedic Association (JOA) scores; complication rates; and reoperation rates for these two surgical procedures in single-level CSM patients. The Mantel-Haenszel method and variance-weighted means were used to analyse outcomes after identifying articles that met study inclusion criteria.

The meta-analysis showed that more surgical time was taken in the c-ADR group (p=0.04). Shorter hospital stays were noted in patients who had undergone c-ADR (p=0.04). In addition, 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 also 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).


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