Adjacent segment degeneration incidence uninfluenced by Total Disc Arthroplasty .
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by one or more authors of the
original publication.
Questo studio è stato identificato come potenzialmente ad alto impatto.
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(8):23 Spine Journal; 2010; 10; 1043-104893 patients, with mono or bi-level cervical disc symptomatic disease and upon failure of conservative treatment, were randomized to undergo total disc arthroplasty (TDA) or anterior cervical discectomy and fusion (ACDF). Primary Outcome Measures were Visual Analogue Score (VAS), Neck Disability Index and Radiographic Assessment were made at different time points until 48 months. Both the ACDF and TDA procedures were found to be equivalent for rendering pain relief in both mono and bi level disc disease and had equivalent risks for inducing adjacent segment degeneration. Interestingly, it was observed that patients with concurrent degenerative disc disease of the lumbar spine had greater likelihood of developing adjacent segment degeneration.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Sì = 1
Incerto = 0,5
Non rilevante = 0
No = 0
La valutazione dei criteri di segnalazione valuta la trasparenza con cui gli autori riportano le caratteristiche metodologiche e sperimentali dello studio all'interno della pubblicazione. La valutazione è suddivisa in cinque categorie che vengono presentate di seguito.
3/4
Randomization
3/4
Outcome Measurements
1/4
Inclusion / Exclusion
4/4
Therapy Description
3/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
L'Indice di Fragilità è uno strumento che aiuta l'interpretazione dei risultati significativi, fornendo una misura della forza di un risultato. L'Indice di Fragilità rappresenta il numero di eventi consecutivi che devono essere aggiunti a un risultato dicotomico per rendere il risultato non più significativo. Un numero piccolo rappresenta un risultato più debole, mentre un numero grande rappresenta un risultato più forte.
Perché questo studio era necessario ora?
Anterior cervical discectomy and fusion (ACDF) is an established treatment for the degenerative disc disease of the cervical spine; however, the development of implants and procedures to restore motion, segmental anatomy, and function shows success after further investigation. The purpose of this study was to compare the incidence of adjacent segment disease in patients treated for degenerative disc disease with either total disc arthroplasty or anterior cervical discectomy and fusion.
Qual era la domanda di ricerca principale?
Is there a difference in incidence of adjacent segment disease after patients with degenerative disc disease are treated with either total disc arthroplasty or anterior cervical discectomy and fusion?
- The success rates were similar in procedures, 71% in TDA and 73.5% in ACDF, and median symptom-free survival period was 39.79+/-1.9 months for ACDF and 38.09+/- 1.9 months for TDA patients. Smokers had a trend towards worse survival rates (p=0.17) for both procedures.
- VAS and NDI scale were similar between groups (p-value = 0.693)
- No statistical difference was noted between groups in terms of development of adjacent lumbar disease (p-value = 0.885)
- Presence of documented lumbar disease was a statistically significant risk factor for development of adjacent lumbar disease (p-value = 0.016)
Che cosa devo ricordare di più?
Total disc arthroplasty and anterior cervical discectomy and fusion have the same clinical outcomes. However, lumbar disease increases the risk of adjacent cervical degenerative disc disease.
Come influenzerà l'assistenza ai miei pazienti?
This study suggests that both techniques are equivalent in treating degenerative disc disease and do not increase risk of adjacent lumbar disease compared to one another. The study also notes that lumbar disease is a significant risk factor for development of adjacent cervical degenerative disc disease. Therefore, it is recommended that physicians consider other factors before considering which treatment is most appropriate for patients.
DISCLAIMER
Il contenuto di questa pagina è solo a scopo informativo e non intende sostituire la consulenza, la diagnosi o il trattamento medico professionale. Se ha bisogno di cure mediche, si rivolga sempre al suo medico o al pronto soccorso più vicino. Le opinioni, le convinzioni e i punti di vista espressi dalle persone sui contenuti presenti in questa pagina non riflettono le opinioni, le convinzioni e i punti di vista di OrthoEvidence.
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