Meta-analysis Of Artificial Disc Replacement Versus Anterior Cervical Discectomy And Fusion For Double Segment Cervical Disc Disease

Objective:To assess and compare the therapeutic effectiveness of total cervical disc replacement(TDR)and anterior cervical discectomy and fusion(ACDF)for double segment cervical disc disease.Method: We do our search in Pub Med,Medline,Embase.The criterias of articles we need for system assessment should include:(1)clinical control trails with application of two kinds of surgical treatment with double segmental cervical spondylosis.(2)the treatment group receives surgery of cervical disc replacement,while the control group receives surgery of ACDF.(3)the number of patients both in treatment group and control group must be more than 10.(4)the evaluation of postoperative effects must include visual analog scale(VAS)neck disability index(NDI)and the range of motion(ROM)of targeted levels etc.Doowns And Black Score And NOS Score were applied to evaluate the quality of included studies.Result: There are 5 studies which include 593 patients(314 patients for TDR,279 patients for ACDF)in our system assessment.All articles are from English literature,among them 2 for random controlled trails while else for prospective cohort study.The score of evaluation for study quality in Doowns And Black Score system are 18 and above,in NOS Score system are 6 stars and above.The meta-analysis pooled effect index,comparing the two groups,standardized mean differences(SMD)of neck pain VAS score and relative risk(RR)of adverse events in two groups are no significant difference(P > 0.05);The standardized mean differences(SMD)of upper limb pain VAS score,NDI score,ROM of flexion and extension of adjacent segment and adjacent segment degeneration,TDR is lower than ACDF group(P < 0.05);For SF36 PCS body health score and ROM of flexion and extension of operated segment,TDR is higher than the ACDF group(P < 0.05).Conclusion: Our results indicate that total cervical disc replacement for double segmental cervical disc disease is safe,and is superior than ACDF for therapeutic effectiveness,but this need more large sample randomized controlled trials,and longer follow-up to test.