Cervical disc arthroplasty vs. ACDF for cervical disc disease .
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2015;3(9):23 PLoS One. 2015 Mar 30;10(3):e011782619 randomized controlled trials were included in this systematic review and meta-analysis comparing outcomes following cervical disc arthroplasty (CDA) versus anterior cervical discectomy and fusion (ACDF). CDA resulted in lower Neck Disability Index scores and greater rates of at least a minimum 15-point improvement on the NDI, lower pain scores, higher range of motion at the operated level, lower rates of secondary surgery at the operated level in the short- and mid-term, lower rates of secondary surgery at adjacent levels in the short-term, and higher rate of overall success (min. 15-pt improvement in NDI, improvement or maintenance of neurological status, and no experience of severe adverse event) when compared to ACDF.
Were the search methods used to find evidence (original research) on the primary question or questions stated?
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Were the criteria used for deciding which studies to include in the overview reported?
Was the bias in the selection of studies avoided?
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Was the validity of all of the studies referred to in the text assessed with use of appropriate criteria (either in selecting the studies for inclusion or in analyzing the studies that were cited)?
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Sí = 1
Incierto = 0,5
No relevante = 0
No = 0
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Introduction
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Accessing Data
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Analysing Data
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Results
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Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
El Índice de Fragilidad es una herramienta que ayuda en la interpretación de hallazgos significativos, proporcionando una medida de fuerza para un resultado. El Índice de Fragilidad representa el número de eventos consecutivos que es necesario añadir a un resultado dicotómico para que el hallazgo deje de ser significativo. Un número pequeño representa un hallazgo más débil y un número grande un hallazgo más fuerte.
¿Por qué se necesitaba ahora este estudio?
Degenerative cervical disc disease is a relatively prevalent condition causing neck pain and disability. In patients unresponsive to conservative treatment, surgery may be considered. Anterior cervical decompression and fusion (ACDF) has long been performed in these cases, although more recently, cervical disc arthroplasty (CDA) has emerged as an effective treatment method. A recent point of interest in comparisons between these two methods of treatment is the incidence of adjacent segment degeneration, which is currently debated.
¿Cuál era la pregunta principal de la investigación?
How does efficacy and safety compare between CDA and ACDF in the treatment of cervical disc disease?
- NDI scores were significantly lower with CDA versus ACDF at both short-term (6 studies; SMD -0.35 [95%CI -0.68, 0.00]; p=0.05) and mid-term follow-up (2 studies; SMD -0.31 [95%CI -0.47, -0.15]; p=0.0002). Rate of NDI improvement >15 pts was also significantly higher with CDA versus ACDF (5 studies; OR 0.72 [95%CI 0.54, 0.95]; p=0.02).
- NRS and VAS neck pain scores were both demonstrated to be significantly lower with CDA versus ACDF at short-term follow-up (p=0.04 and 0.004, respectively). VAS arm pain scores were also significantly lower with CDA (p=0.02), though no significant difference was observed for NRS arm pain (p=0.56). Both NRS neck and arm pain scores at mid-term follow-up were significantly lower with CDA versus ACDF (p=0.0008 and 0.02, respectively).
- Short-term SF-36 PCS and MCS scores demonstrated no significant differences between CDA and ACDF in health-related quality of life (PCS: SMD -0.07 [95%CI -0.20, 0.06], p=0.28; MCS: SMD 0.05 [95%CI -0.13, 0.22], p=0.62).
- CDA demonstrated significantly higher range of motion (ROM) at the operated level compared to ACDF (SMD -5.20 [95%CI -6.77, -3.72]; p<0.00001). No difference was noted between CDA and ACDF when considering ROM of the superior level (SMD 0.42 [95%CI -0.28, 1.12]; p=0.24) or inferior level (SMD -0.90 [95%CI -1.84, 0.04]; p=0.06).
- In the short-term, CDA demonstrated lower rates of secondary surgery at both the operated level (OR 0.32 [95%CI 0.19, 0.53]; p<0.00001) and adjacent levels (OR 0.28 [95%CI 0.11, 0.72]; p=0.008). In the mid-term, rate of secondary surgery at the operated level remained significantly lower following CDA (OR 0.45 [95%CI 0.29, 0.68]; p=0.0002), though the difference in rate of secondary surgery at adjacent levels was no longer significant (OR 0.76 [95%CI 0.47, 1.22]; p=0.25).
- Rate of overall success (defined as min. 15-pt improvement in NDI, improvement or maintenance of neurological status, and no experience of severe adverse event) was significantly higher following CDA compared to ACDF (OR 0.59 [95%CI 0.48, 0.74]; p<0.00001).
¿Qué es lo que más debo recordar?
Cervical disc arthroplasty was statistically favoured when considering pooled results of Neck Disability Index outcome at short and mid-term, neck pain in the short- and mid-term, range of motion at the operated level in the short-term, secondary surgery at the operated and adjacent levels in the short-term, secondary surgery at the operated level in the mid-term, and overall success rate when compared to anterior cervical discectomy and fusion.
¿Cómo afectará esto al cuidado de mis pacientes?
The results of this review and meta-analysis suggest that outcomes may be favourable following cervical disc arthroplasty when compared to anterior cervical disc arthroplasty. Additional studies with extended follow-up, and examining the progression of adjacent segment degeneration over the long-term are needed to more widely explore the long-term efficacy of these two surgical treatment options.
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