Bryan Cervical Disc Arthroplasty Versus Anterior Cervical Discectomy and Fusion for Treatment of Cervical Disc Diseases: A Meta-analysis of Prospective, Randomized Controlled Trials

摘要

Study Design.A meta-analysis of randomized controlled trials (RCTs).Objective.The purpose of this study is to evaluate the effectiveness and safety of Bryan cervical disc arthroplasty (BCDA) as compared with anterior cervical discectomy and fusion (ACDF) for treatment of cervical disc diseases (CDDs).Summary of Background Data.Previous meta-analyses focused on the comparison of effectiveness and safety between ACDF and CDA, which consisted of various types of disc prostheses. No meta-analysis has been conducted up to present to compare ACDF with a specialized type of artificial cervical disc.Methods.We comprehensively searched PubMed, EMBASE, and Cochrane Central Register of Controlled Trails for prospective RCTs that compared BCDA with ACDF. The retrieved results were last updated on October 1, 2015, without language restrictions. We classified the trials into subgroups by short-term and midterm follow-up.Results.Eight relevant RCTs involving 1816 individuals were included in the meta-analysis. In overall-term follow-up, the clinical outcomes indicated that BCDA was superior to ACDF considering lower NDI scores (P=0.0009), greater range of motion at the index level (P=0.02), and fewer adverse events (P=0.004), but inferior to ACDF considering operation time (P<0.00001). There was no significant difference between two groups regarding blood loss (P=0.43), length of hospital stay (P=0.12), and secondary surgical procedures (P=0.20).Conclusion.BCDA presented better NDI improvement, greater range of motion at the index level, and fewer adverse events. However, the benefits of BCDA considering blood loss, length of hospital stay, and secondary surgical procedures are still incapable to be proved. More well design studies with longer term follow-up are needed to provide a better evaluation of the effectiveness and safety of the two procedures.Level of Evidence: 1