A systematic review of randomized trials on the effect of cervical disc arthroplasty on reducing adjacent-level degeneration

Anterior cervical discectomy and fusion had been considered a safe and effective procedure for radiculopathy and myelopathy in the cervical spine, but degeneration in adjacent spinal levels has been a problem in some patients after fusion. Since 2002, cervical disc arthroplasty has been established...

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Bibliographic Details
Published in:	Neurosurgical focus Vol. 28; no. 6; p. E5
Main Authors:	Botelho, Ricardo Vieira, Moraes, Osmar José dos Santos, Fernandes, Gustavo Alberto, Buscariolli, Yuri dos Santos, Bernardo, Wanderley Marques
Format:	Journal Article
Language:	English
Published:	United States 01-06-2010
Subjects:	Arthroplasty - adverse effects Arthroplasty - methods Arthroplasty - statistics & numerical data Cervical Vertebrae - diagnostic imaging Cervical Vertebrae - pathology Cervical Vertebrae - surgery Disease Progression Diskectomy - adverse effects Diskectomy - methods Diskectomy - statistics & numerical data Humans Intervertebral Disc Displacement - pathology Intervertebral Disc Displacement - physiopathology Intervertebral Disc Displacement - surgery Postoperative Complications - epidemiology Postoperative Complications - physiopathology Postoperative Complications - prevention & control Radiography Randomized Controlled Trials as Topic Secondary Prevention Spinal Fusion - adverse effects Spinal Fusion - methods Spinal Fusion - statistics & numerical data Spondylosis - pathology Spondylosis - physiopathology Spondylosis - surgery
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Summary:	Anterior cervical discectomy and fusion had been considered a safe and effective procedure for radiculopathy and myelopathy in the cervical spine, but degeneration in adjacent spinal levels has been a problem in some patients after fusion. Since 2002, cervical disc arthroplasty has been established as an alternative to fusion. The objective of this study was to review data concerning the role of cervical arthroplasty in reducing adjacent-level degeneration. A systematic review was performed using the MEDLINE, EMBASE, Cochrane, and LILACS databases, focusing on a structured question involving the population of interest, types of intervention, types of control, and outcomes studied. No study has specifically compared the results of arthroplasty with the results of fusion with respect to the rate of postoperative development of adjacent-segment degenerative disease. One paper described a rate for adjacent-level surgery. The level of evidence of that paper was classified 2b, and although its authors found a statistically significant between-groups difference (arthroplasty vs fusion) using log-rank analysis, re-analysis according to number needed to treat (in the current paper) did not reveal statistical significance. Adjacent-level degeneration has not been adequately studied in a review of the available randomized controlled trials on this topic, and there is no clinical evidence of reduction in adjacent-level degeneration with the use of cervical arthroplasty.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 ObjectType-Review-4 content type line 23 ObjectType-Undefined-3
ISSN:	1092-0684 1092-0684
DOI:	10.3171/2010.3.FOCUS1032