Open AccessSecondary Surgery after Cervical Disc Arthroplasty versus Fusion for Cervical Degenerative Disc Disease: A Meta‐analysis with Trial Sequential Analysis
Author(s) -
Zhu Rusen,
Kan Shunli,
Cao Zegang,
Jiang Zehua,
Zhang Xueli,
Hu Wei
Publication year - 2018
Publication title -
orthopaedic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.666
H-Index - 23
eISSN - 1757-7861
pISSN - 1757-7853
DOI - 10.1111/os.12401
Subject(s) - medicine , anterior cervical discectomy and fusion , meta analysis , confidence interval , surgery , degenerative disc disease , relative risk , arthroplasty , randomized controlled trial , cochrane library , cervical spine , lumbar
The purpose of this meta‐analysis was to explore whether cervical disc arthroplasty (CDA) was superior to anterior cervical discectomy and fusion (ACDF) in reducing secondary surgery. PubMed, EMBASE, and the Cochrane Library databases were systematically searched. Outcomes were reported as relative risk ( RR ) with the corresponding 95% confidence interval ( CI ). The pooled data was calculated using a random‐effect model. We also used the trial sequential analysis (TSA) to further verify our results and obtain more moderate estimates. Twenty‐one studies with 4208 patients were included in this meta‐analysis. The results indicated that compared with ACDF, CDA had fewer frequency of secondary surgery at the index level ( RR , 0.47; 95% CI , 0.36–0.63; P < 0.05) and adjacent level ( RR , 0.48; 95% CI , 0.36–0.65; P < 0.05), and the differences were statistically significant. In addition, in terms of the overall frequency of secondary surgery at the index and adjacent level, CDA was also significantly superior to ACDF ( RR , 0.49; 95% CI , 0.41–0.60; P < 0.05). TSA demonstrated that adequate and decisive evidence had been established. Regarding the frequency of secondary surgery, CDA was significantly superior to ACDF. It was supposed that CDA may be a better surgical intervention to reduce the rate of secondary surgery for patients with cervical degenerative disc disease.