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Comparison of Multilevel Cervical Disc Replacement and Multilevel Anterior Discectomy and Fusion: A Systematic Review of Biomechanical and Clinical Evidence.

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机构： [1]State Key Laboratory of Tribology, Tsinghua University, Beijing, China and Department of Mechanical Engineering, Tsinghua University, Beijing, China [2]Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA [3]School of Pharmacy, Peking University, Beijing, China [4]Biomechanics and Biotechnology Laboratory, Research Institute of Tsinghua University in Shenzhen, Shenzhen, People’s Republic of China [5]Department of Mechanical Engineering, Tsinghua University, Beijing, People’s Republic of China [6]Biomechanics and Biotechnology Laboratory, Research Institute of Tsinghua University in Shenzhen, Shenzhen, People’s Republic of China

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The aim of this study was to comprehensively compare the clinical and biomechanical efficiency of anterior cervical discectomy and fusion (ACDF) with anterior cervical disc replacement (ACDR) for treatment of multilevel cervical disc disease using a meta-analysis and systematical review. A literature search was performed using PubMed, MEDLINE, EMBASE, and the Cochrane Library for articles published between January 1960 and December 2017. Both clinical and biomechanical parameters were analyzed. Statistical tests were conducted by Revman 5.3. Nineteen studies including 10 clinical studies and 9 biomechanical studies were filtered out. The pooled results for clinical efficiency showed that no significant difference was observed in blood loss (P = 0.09; mean difference [MD], 7.38; confidence interval [CI], -1.16 to 15.91), hospital stay (P = 0.33; MD, -0.25; CI, -0.76 to 0.26), Japanese Orthopaedic Association scores (P = 0.63; MD, -0.11; CI, -0.57 to 0.34), visual analog scale (P = 0.08; MD, -0.50; CI, -1.06 to 0.05), and Neck Disability Index (P = 0.33; MD, -0.55; CI, -1.65 to 0.56) between the 2 groups. Compared with ACDF, ACDR did show increased surgical time (P = 0.03; MD, 31.42; CI, 2.71-60.14). On the other hand, ACDR showed increased index range of motion (ROM) (P < 0.00001; MD, 13.83; CI, 9.28-18.39), lower rates of adjacent segment disease (ASD) (P = 0.001; odds ratio [OR], 0.27; CI, 0.13-0.59), complications (P = 0.006; OR, 0.62; CI, 0.45-0.87), and rate of subsequent surgery (P < 0.00001; OR, 0.25; CI, 0.14-0.44). As for biomechanical performance, ACDR maintained index ROM and avoided compensation in adjacent ROM and tissue pressure. Multilevel ACDR may be an effective and safe alternative to ACDF in terms of clinical and biomechanical performance. However, further multicenter and prospective studies should be conducted to obtain a stronger and more reliable conclusion. Copyright © 2018 Elsevier Inc. All rights reserved.

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出版当年[2017]版：

大类 | 3 区医学

小类 | 3 区临床神经病学 3 区外科

最新[2023]版：

大类 | 4 区医学

小类 | 4 区临床神经病学 4 区外科

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第一作者机构： [1]State Key Laboratory of Tribology, Tsinghua University, Beijing, China and Department of Mechanical Engineering, Tsinghua University, Beijing, China

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通讯机构： [5]Department of Mechanical Engineering, Tsinghua University, Beijing, People’s Republic of China [6]Biomechanics and Biotechnology Laboratory, Research Institute of Tsinghua University in Shenzhen, Shenzhen, People’s Republic of China

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