Comparison of outcomes between cervical disc arthroplasty and anterior cervical discectomy and fusion for the treatment of cervical spondylotic myelopathy: a systematic review and meta-analysis.

Abstract

The management of cervical spondylotic myelopathy (CSM) presents a clinical conundrum, with cervical disc arthroplasty (CDA) and anterior cervical discectomy and fusion (ACDF) emerging as primary contenders. However, the comparative advantages and limitations of these interventions remain contentious. This meta-analysis aimed to scrutinize the efficacy and safety profiles of CDA and ACDF in addressing CSM. Adhering rigorously to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the authors conducted an exhaustive systematic search across reputable databases including PubMed, Embase, Web of Science, Cochrane Library, Scopus, and the Chinese National Knowledge Infrastructure. Randomized controlled trials evaluating the efficacy and safety of CDA versus ACDF for CSM were meticulously selected for comprehensive evaluation. A total of 12 randomized controlled trials involving 2612 patients (1464 CDA, 1148 ACDF) were included in this meta-analysis. The pooled results showed that compared with ACDF, CDA was associated with better overall success (RR 1.21, 95% CI 1.06-1.37; p = 0.004; I2 = 71%). In terms of Neck Disability Index and neck visual analog scale (VAS), compared with ACDF, the CDA group showed superior performance at 6 weeks, 3 months, 6 months, 12 months, and 24 months after surgery. The performance on the arm VAS at 3 and 12 months after surgery was the same. The operative time for the CDA group was significantly longer than that of the ACDF group. There were no significant differences in neurological success; radiological success; arm VAS scores at 6 weeks, 6 months, and 24 months postoperatively; range of motion; SF-36 mental component summary and physical component summary scores; surgical blood loss; dysphagia/dysphonia; and rate of any adverse event. In contrast to ACDF, CDA exhibited superior clinical efficacy and a more favorable safety profile in the management of CSM. Notably, discernible disparities were observed in the enhancement of neck pain as measured by the VAS within the initial postoperative year. It is imperative to note, however, that the body of evidence supporting these conclusions remains relatively scant, necessitating comprehensive validation through expanded multicenter randomized controlled trials encompassing substantial sample sizes.