• Hua Jiang, Zezhang Zhu, Yong Qiu, Bangping Qian, Xusheng Qiu, and Mingliang Ji.
• Department of Orthopedics and Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing 210008, People's Republic of China.
• Arch Orthop Trauma Surg. 2012 Feb 1;132(2):141-51.

ObjectiveTo evaluate the safety and effectiveness of cervical disc arthroplasty (CDA) versus anterior cervical discectomy and fusion (ACDF) for single-level symptomatic cervical disc disease.MethodsWe identified eligible randomized controlled trials (RCTs) in PubMed (April 2011), EMBASE (April 2011) and Cochrane Central Register of Controlled Trials (April 2011). Data were collected and extracted by two reviewers independently. The methodological quality and clinical relevance of the included studies were assessed. Data analysis was conducted with RevMan 5.0.ResultsSix RCTs involving 1,745 patients were included. The pooled analysis showed a higher prevalence of neurological and overall success [(P = 0.004, RR = 1.06, 95% CI = 1.02-1.10), (P = 0.0005, RR = 1.14, 95% CI = 1.06-1.22)], and a lower incidence of dysphagia and reoperation related to adjacent-segment degeneration [(P = 0.04, RR = 0.30, 95% CI = 0.09-0.97), (P = 0.03, RR = 0.46, 95% CI = 0.23-0.91)] with CDA compared to ACDF. However, there was no statistical difference in neck disability index (P = 0.92, SMD = 0.01, 95% CI = -0.25 to 0.27), neck and arm pain scores[(P = 0.33, SMD = -0.12, 95% CI = -0.37 to 0.13), (P = 0.54, SMD = 0.17, 95% CI = -0.36 to 0.70)], incidence of complications related to the implant or surgical procedure and reoperation related to primary surgery [(P = 0.32, RR = 0.76, 95% CI = 0.45-1.30), (P = 0.09, RR = 0.48, 95% CI = 0.20-1.12)].ConclusionCompared with ACDF, CDA carry a lower incidence of dysphagia complications and reoperation related to adjacent-segment degeneration, and a higher prevalence of neurological and overall success at 2 years postoperatively. As the poor quality of the included studies, it is still uncertain whether CDR is more effective and safer than ACDF treating single-level symptomatic cervical disc disease. Future large-scale RCTs with long-term follow-up are needed to provide clear evidence.

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