Clinical Outcomes Are Similar Following Anterior Cervical Discectomy and Fusion Versus Cervical Disc Arthroplasty

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STUDY DESIGN: Systematic review. OBJECTIVE: To compare clinical outcomes of anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) in studies without industry influence. SUMMARY OF BACKGROUND DATA: Both CDA and ACDF are appropriate options for cervical degenerative disc disease. However, most studies investigating this have significant industry influence due to either industry sponsorship or conflicts of interest among authors. METHODS: A systematic review of all studies investigating CDA versus ACDF in the Cochrane and PubMed/EMBASE databases was performed. Studies were excluded if they were supported by industry without investigator independence, had a minimum follow-up <2 years, or were performed outside the United States or Europe. Revision rates, adjacent segment degeneration (ASD) rates, and patient-reported outcomes (PROMs), including Neck Disability Index (NDI) and visual analog scale (VAS) Neck, were extracted. Funnel plots were used to exclude biased studies for each specific outcome measure. Meta-analyses were conducted using random effects modeling and forest plot analysis. RESULTS: Thirteen studies were included with 18,473 patients, of whom 12,270 underwent ACDF and 6203 underwent CDA. Minimum follow-up ranged from 24 to 132 months. Overall, 12/13 (92.3%) of studies were considered high quality. On random effects modeling, patients undergoing ACDF demonstrated higher rates of ASD [risk ratio (RR), 1.70; 95% CI: 1.02-2.84] but there were no differences in subsequent revision (RR, 1.29; 95% CI: 0.99-1.67), VAS Neck [(weighted mean differences (MD), 0.26; 95% CI: -0.38 to 0.90), or NDI (weighted MD, 1.81; 95% CI: -3.54 to 7.15)]. CONCLUSIONS: In this first meta-analysis of all comparative studies between ACDF and CDA without industry influence, we demonstrate that despite a higher rate of ASD among patients undergoing ACDF, there are no long-term differences in revision rates or patient-reported outcomes between CDA and ACDF.

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