Abstract
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.
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@article{pmid24335631,
title = {Rate of adjacent segment disease in cervical disc arthroplasty versus single-level fusion: meta-analysis of prospective studies},
author = {Kushagra Verma and Sapan D Gandhi and Mitchell Maltenfort and Todd J Albert and Alan S Hilibrand and Alexander R Vaccaro and Kristin E Radcliff},
doi = {10.1097/BRS.0000000000000052},
issn = {1528-1159},
year = {2013},
date = {2013-12-01},
urldate = {2013-12-01},
journal = {Spine (Phila Pa 1976)},
volume = {38},
number = {26},
pages = {2253--2257},
abstract = {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.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
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