Lumbar Disc Replacement Versus Fusion For Treatment Of Lumbar Degenerative Disc Disease: A Meta-analysis

BACKGROUND:The new artificial disc replacement concept was proposed in 1960's, which attempted to simulate normal human inter-vertebral disc artificial disc to avoid the negative effects of inter-vertebral fusion. However, it remains controversial in term of the efficacy and safety for the two treatments of lumbar degenerative disc disease (DDD).OBJECTIVE:To assess the effect and the safety of lumbar disc replacement versus fusion for the treatment of degenerative disc disease (DDD)Methods:Cochrane Back Group, the Cochrane library (Number 12,2009), additional electronic database including Medline (1966/2009-12), Embase (1966/2009-12), CBM, CNKI were retrieved for articles of well designed clinical trials related to lumbar disc replacement versus fusion for the treatment of DDD. Chinese Journals were manually searched. Data were extracted and evaluated by two reviewers independently of each other. Among the literature, the test group was treated with artificial disc replacement, while the control group with fusion; The Cochrane Collaboration's RevMan 4.2.2 software was used for data analyses.RESULTS:7 studies including a total of 936 patients met with the enrolling criteria for the study, Meta-analysis indicated that no difference was found in mean blood loss,device success rate,mean operation time or re-operation rate between two groups (P >0.05), but the disc replacement group had lower rate of the complications and higher rate of overall success,patient satisfaction, better VAS and ODI score compared with fusion group (P<0.05). CONCLUSION:The disc replacement group show superior clinic efficacy for the treatment of lumbar DDD at the immediate postoperative time. However, the TDR does not show significant superiority in safety compared with fusion. More randomized controlled trials with long time and high quality are required to draw more definite conclusions.