Ten Year Outcomes of Cervical Disc Arthroplasty vs. Anterior Cervical Discectomy and Fusion

Abstract

Study Design: A systematic review with meta-analysis of randomized controlled trials and comparative retrospective cohort studies. Objective: The purpose of this study is to compare 10-year outcomes of cervical disc arthroplasty with that of anterior cervical discectomy and fusion for the treatment of cervical degenerative disc disease (CDDD). Summary of Background Data: ACDF is a gold standard for the treatment of CDDD. However, the loss of motion at the operated level may accelerate adjacent segment disease. The preservation of motion with CDA attempts to prevent this complication of cervical fusion. Short and midterm data reveal comparable results for CDA versus ACDF, however, long-term results are unknown. Methods: A systematic review with meta-analysis was performed to determine if CDA had improved outcomes compared to ACDF at 10-year follow-up. PubMed and Web of Science database searches through 2023 were performed to identify randomized controlled trials and comparative retrospective cohort studies involving treatment of one or two-level CDDD. Results: Six studies were eligible for analysis. CDA had significantly improved NDI scores, VAS scores for pain, and JOA scores (P < 0.05), however, none of these met minimal clinically important differences (MCID). CDA had significantly fewer secondary surgeries and adverse events (P < 0.05), however, these did not meet MCID. There were no significant differences in neurological success. Conclusions: We found that significantly fewer secondary surgeries and adverse events were seen after CDA than after ACDF at 10-year follow-up. CDA had statistically, but not clinically, improved NDI, VAS, and JOA scores in comparison to ACDF. CDA was not statistically different from ACDF in terms of successful neurologic outcome.