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Evidence summaries

Cervical Disc Prostheses (Arthroplasty) Compared to Fusion of Vertebrae in Single Level Cervical Disc Degeneration

Cervical discectomy with disc prosthese (arthroplasty) allowing normal vertebral mobility appears to be slightly more effective in reducing neck pain and improving neck-related functional status in the short term (1-2 years) compared to discectomy with cervical vertebral fusion in patients with symptomatic single level cervical degenerative disc disease. Level of evidence: "B"

The quality of evidence is downgraded by study limitations (lack of blinding).

Summary

There were nine randomized controlled trials in a Cochrane review [Abstract] 1, [withdrawn from publication] with altogether 2400 participants, comparing neck arthroplasty and fusion. There is low to moderate evidence for a small (less than 10% of the scale) but significant difference in favour of arthroplasty in pain and function at 1-2 years. For neck pain at 3 months there is no significant difference. There was less secondary surgery in the arthroplasty group at the same vertebral level, but there was no significant difference in adjacent level surgery at 1-2 years.

OutcomeNumber of participants (trials)Control:Cervical vertebral fusionIntervention:Cervical disc prosthese (arthroplasty)Effect size (95 % CI)Interpretation
Arm pain at 1 to 2 years: VAS or NRS*1346(6)Mean score ranging from 9.5 to 32.8Mean 1.54 lower ( range 2.86 to 0.22 lower)MD -1.54( -2.86 to -0.22)Small difference in favour of arthroplasty
Neck pain at 1 to 2 years: VAS or NRS*1309(6)Mean score ranging from 16.6 to 35.8Mean 3.12 lower (range 4.96 to 1.28 lower)MD -3.12( -4.69 to -1.2)Small difference in favour of arthroplasty
Neck related functional status at 1 to 2 years: NDI**1505(6)Mean score ranging from 15 to 34.7Mean 2.79 lower(range 4.73 to 0.85 lower)MD -2.79(-4.73 to -0.85)Small difference in favour of arthroplasty
Patient satisfaction at 1 to 2 years498 (2)87/10093/100RR 1.06 (1.00 to 1.12)No difference
Secondary surgery at 1 to 2 years: index level1484(7)47/701 (6.7%)20/783 (2.6%)RR 0.39(0.23 to 0.64)Significant difference in favour of arthroplasty
Secondary surgery at 1 to 2 years: adjacent level1431(6)31/676 (4.6%)20/755 (2.6%)RR 0.60(o.35 to 1.02)No difference
  • *VAS and NRS: Visual Analogue Scale and Numerical Rating Scale, from 0 to 100: 0 = No Pain, 1-39 = Mild Pain (nagging, annoying, interfering little with ADLs); 40-69 = Moderate Pain (interferes significantly with ADLs); 70-100 = Severe Pain (disabling; unable to perform ADLs).
  • **The neck Disability Index NDI, from 0 to 50: 0 - 4 = No disability; 5 - 14 = Mild disability; 15 - 24 = Moderate disability; 25 - 34 = Severe disability; 35 or over = Complete disability
Clinical comment

Given the current absence of truly long-term results, use of mobile disc prostheses should still be limited to clinical trials.

Note

Date of latest search: 25.05.2011

References

  • Boselie TF, Willems PC, van Mameren H et al. WITHDRAWN: Arthroplasty versus fusion in single-level cervical degenerative disc disease. Cochrane Database Syst Rev 2015;(5):CD009173. [PubMed]

Primary/Secondary Keywords