Systematic Review and Meta-analysis of Randomized Controlled Trials: Comparison of Total Disk Replacement With Anterior Cervical Decompression and Fusion

<jats:p> The authors performed a systematic review and meta-analysis to evaluate whether there is a beneficial clinical effect of total disk replacement compared with anterior cervical diskectomy and fusion for the treatment of single-level symptomatic cervical disk disease. A comprehensive literature search of multiple databases, including PubMed (1966–2011), Cochrane Controlled Trials Register (CENTRAL; issue 1, 2011), and Embase (1984–2011), was conducted to identify studies that met the inclusion criteria. Methodologic quality was assessed and relevant data were retrieved, and if appropriate, meta-analysis was performed. Eight randomized controlled trials were identified; six of the 8 reported 24-month follow-up results. At 24 months, total disk replacement was demonstrated to be more beneficial for patients compared with anterior cervical diskectomy and fusion for the following outcomes: overall success rate (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.37–2.33; <jats:italic>P</jats:italic> <.0001), overall reoperation rate (OR,.36; CI, .21–.61; <jats:italic>P</jats:italic> =0), reoperation rate for revision (OR, .12; CI, .02 to .64; <jats:italic>P</jats:italic> =.01), and visual analog scale neck pain scores (standard mean differences [SMD], −.48; CI, −.91 to −.05; <jats:italic>P</jats:italic> =.03). Other outcomes, including Neck Disability Index scores (SMD, −.02; CI, −.44 to .27; <jats:italic>P</jats:italic> =.67) and visual analog scale arm pain scores (SMD, −.21; CI, −.63 to .22; <jats:italic>P</jats:italic> =.34), demonstrated no differences between the 2 groups. For patients with single-level symptomatic cervical disk disease, total disk replacement was found to be more effective than anterior cervical diskectomy and fusion in the 2 outcomes of overall success rate and overall reoperation rate at 24 months. Long-term results also showed total disk replacement trended to be more effective than anterior cervical diskectomy and fusion in some aspects. </jats:p>