Efficacy and Safety of Total Disc Replacement Compared With Anterior Cervical Discectomy and Fusion in the Treatment of Cervical Disease A Meta-analysis

Study Design. Meta-analysis. Objective. The aim of this study was to evaluate the efficacy and safety of total disc replacement (TDR) and anterior cervical discectomy and fusion (ACDF) for treating cervical degenerative diseases. Summary of Background Data. ACDF has been the traditional criterion standard surgery for cervical degenerative diseases. Methods. Clinical databases including PubMed, MEDLINE, Cochrane, and Clinical Trials.gov were searched. Review Manager 5.1 software and Stata 11.1 were used to analyze clinical data. Dichotomous pooled results were reported as relative risk (RR) and its 95% confidence interval (CI). Endpoints included clinical success rate, neck disability index (NDI) success rate, neurological success rate, incidence of adverse event, reoperation rate, and patient satisfaction. Results. Eight clinical trials and fifteen papers with 1440 TDR patients and 1237 ACDF patients were included in this metaanalysis. The TDR group had a higher clinical success rate (RR 1.26; 95% CI 1.13-1.41; P < 0.001; I-2 = 79%), NDI success rate (RR 1.16; 95% CI 1.06-1.26; P = 0.001; I-2 = 77%), neurological success rate (RR 1.06; 95% CI 1.03-1.10; P = 0.0004; I-2 = 58%), and secondary surgery rate (RR 1.06; 95% CI 1.03-1.09; P < 0.001; I-2 = 0%), but lower secondary surgery rate (RR 0.44; 95% CI 0.31-0.63; P < 0.00001; I-2 = 43%) compared with the ACDF group. There was no significant difference in the adverse event rate between the TDR group and the CDF group (RR 0.44; 95% CI 0.31-0.63; P < 0.001; I-2 = 43%). Conclusion. From the meta-analysis, we conclude that the efficacy and safety of TDA are equivalent or superior to ACDF. TDR is associated with a higher overall success rate, NDI success rate, neurological success rate, reoperation rate, and satisfaction rate compared with ACDF group. No differences exist in the risk of adverse event between the two groups.