Cervical disc arthroplasty vs. ACDF for cervical disc disease .
Questo studio è stato identificato come potenzialmente ad alto impatto.
La metrica High Impact di OE, guidata dall'AI, stima l'influenza che un articolo potrebbe avere integrando i segnali della rivista in cui è stato pubblicato e il contenuto scientifico dell'articolo stesso.
Sviluppato utilizzando un'elaborazione del linguaggio naturale all'avanguardia, il modello High Impact di OE prevede in modo più accurato la futura performance citazionale di uno studio rispetto al solo fattore di impatto della rivista.
Ciò consente di riconoscere prima le ricerche clinicamente significative e aiuta i lettori a concentrarsi sugli articoli che hanno maggiori probabilità di influenzare la pratica futura.
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?
Was the search for evidence reasonably comprehensive?
Were the criteria used for deciding which studies to include in the overview reported?
Was the bias in the selection of studies avoided?
Were the criteria used for assessing the validity of the included studies reported?
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)?
Were the methods used to combine the findings of the relevant studies (to reach a conclusion) reported?
Were the findings of the relevant studies combined appropriately relative to the primary question that the overview addresses?
Were the conclusions made by the author or authors supported by the data and or analysis reported in the overview?
How would you rate the scientific quality of this evidence?
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.
4/4
Introduction
4/4
Accessing Data
4/4
Analysing Data
4/4
Results
3/4
Discussion
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?
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.
Qual era la domanda di ricerca principale?
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).
Che cosa devo ricordare di più?
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.
Come influenzerà l'assistenza ai miei pazienti?
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.
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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