PMID- 22912869
OWN - NLM
STAT- MEDLINE
DCOM- 20130306
LR  - 20240318
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 7
IP  - 8
DP  - 2012
TI  - Anterior cervical discectomy with arthroplasty versus arthrodesis for 
      single-level cervical spondylosis: a systematic review and meta-analysis.
PG  - e43407
LID - 10.1371/journal.pone.0043407 [doi]
LID - e43407
AB  - OBJECTIVE: To estimate the effectiveness of anterior cervical discectomy with 
      arthroplasty (ACDA) compared to anterior cervical discectomy with fusion (ACDF) 
      for patient-important outcomes for single-level cervical spondylosis. DATA 
      SOURCES: Electronic databases (MEDLINE, EMBASE, Cochrane Register for Randomized 
      Controlled Trials, BIOSIS and LILACS), archives of spine meetings and 
      bibliographies of relevant articles. STUDY SELECTION: We included RCTs of ACDF 
      versus ACDA in adult patients with single-level cervical spondylosis reporting at 
      least one of the following outcomes: functionality, neurological success, neck 
      pain, arm pain, quality of life, surgery for adjacent level degeneration (ALD), 
      reoperation and dysphonia/dysphagia. We used no language restrictions. We 
      performed title and abstract screening and full text screening independently and 
      in duplicate. DATA SYNTHESIS: We used random-effects model to pool data using 
      mean difference (MD) for continuous outcomes and relative risk (RR) for 
      dichotomous outcomes. We used GRADE to evaluate the quality of evidence for each 
      outcome. RESULTS: Of 2804 citations, 9 articles reporting on 9 trials (1778 
      participants) were eligible. ACDA is associated with a clinically significant 
      lower incidence of neurologic failure (RR = 0.53, 95% CI = 0.37-0.75, p = 0.0004) 
      and improvement in the Neck pain visual analogue scale (VAS) (MD = 6.56, 95% CI = 
      3.22-9.90, p = 0.0001; Minimal clinically important difference (MCID) = 2.5. ACDA 
      is associated with a statistically but not clinically significant improvement in 
      Arm pain VAS and SF-36 physical component summary. ACDA is associated with 
      non-statistically significant higher improvement in the Neck Disability Index 
      Score and lower incidence of ALD requiring surgery, reoperation, and 
      dysphagia/dysphonia. CONCLUSIONS: There is no strong evidence to support the 
      routine use of ACDA over ACDF in single-level cervical spondylosis. Current 
      trials lack long-term data required to assess safety as well as surgery for ALD. 
      We suggest that ACDA in patients with single level cervical spondylosis is an 
      option although its benefits and indication over ACDF remain in question.
FAU - Fallah, Aria
AU  - Fallah A
AD  - Division of Neurosurgery, University of Toronto, Toronto, Canada. 
      aria.fallah@mail.utoronto.ca
FAU - Akl, Elie A
AU  - Akl EA
FAU - Ebrahim, Shanil
AU  - Ebrahim S
FAU - Ibrahim, George M
AU  - Ibrahim GM
FAU - Mansouri, Alireza
AU  - Mansouri A
FAU - Foote, Clary J
AU  - Foote CJ
FAU - Zhang, Yuqing
AU  - Zhang Y
FAU - Fehlings, Michael G
AU  - Fehlings MG
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20120817
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
SB  - IM
MH  - Arthroplasty/*methods
MH  - Cervical Vertebrae/*surgery
MH  - Diskectomy/*methods
MH  - Humans
MH  - Outcome Assessment, Health Care/methods
MH  - Randomized Controlled Trials as Topic
MH  - Spinal Fusion/*methods
MH  - Spondylosis/pathology/*surgery
PMC - PMC3422251
COIS- Competing Interests: The authors have declared that no competing interests exist.
EDAT- 2012/08/23 06:00
MHDA- 2013/03/07 06:00
PMCR- 2012/08/17
CRDT- 2012/08/23 06:00
PHST- 2012/05/08 00:00 [received]
PHST- 2012/07/24 00:00 [accepted]
PHST- 2012/08/23 06:00 [entrez]
PHST- 2012/08/23 06:00 [pubmed]
PHST- 2013/03/07 06:00 [medline]
PHST- 2012/08/17 00:00 [pmc-release]
AID - PONE-D-12-13307 [pii]
AID - 10.1371/journal.pone.0043407 [doi]
PST - ppublish
SO  - PLoS One. 2012;7(8):e43407. doi: 10.1371/journal.pone.0043407. Epub 2012 Aug 17.