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Clinical Effectiveness of Artificial Disc Replacement in Comparison With Anterior Cervical Discectomy and Fusion in the Patients With Cervical Myelopathy: Systematic Review and Meta-analysis
OBJECTIVE: Cervical myelopathy (CM) describes the compressive cervical spinal cord state, often accompanied by serious clinical condition, by herniated disc or hypertrophied spurs or ligament. Anterior cervical discectomy and fusion (ACDF) has been frequently employed as conventional surgical soluti...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Korean Spinal Neurosurgery Society
2023
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10562247/ https://www.ncbi.nlm.nih.gov/pubmed/37798997 http://dx.doi.org/10.14245/ns.2346498.249 |
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author | Lee, Jung Hwan Lee, Youn Joo Chang, Min Cheol Lee, Jun Ho |
author_facet | Lee, Jung Hwan Lee, Youn Joo Chang, Min Cheol Lee, Jun Ho |
author_sort | Lee, Jung Hwan |
collection | PubMed |
description | OBJECTIVE: Cervical myelopathy (CM) describes the compressive cervical spinal cord state, often accompanied by serious clinical condition, by herniated disc or hypertrophied spurs or ligament. Anterior cervical discectomy and fusion (ACDF) has been frequently employed as conventional surgical solution for this CM despite its inherent biomechanical handicap. Alternatively, an artificial disc replacement (ADR) preserves cervical motion while still decompressing the spinal canal and neural foramen. This analysis elaborated to clarify the potential benefits of ADR application to CM over ACDF from the conglomerated results of the past references. METHODS: A literature search was performed using MEDLINE, Embase, Cochrane review, and KMbase databases from the studies published until March 2023. Six studies (3 randomized controlled study [RCTs] and 3 non-RCTs) were included in a qualitative and quantitative synthesis. Data were extracted and analyzed using a random effects model to obtain effect size and its statistical significance. Quality assessment and evidence level were established in accordance with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. RESULTS: Among 6 studies, 2 studies showed that ADR group achieved significantly better clinical improvement than the ACDF group, while the rest 4 studies revealed no significant difference. A meta-analysis showed better clinical outcomes with or without statistical significance. The level of evidence was low because of inconsistency and imprecision. CONCLUSION: ADR was superior or at least, not inferior to ACDF in terms of functional recovery. However, its application to the CM patients is merely empowered with weak strength due to low level of evidence. |
format | Online Article Text |
id | pubmed-10562247 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Korean Spinal Neurosurgery Society |
record_format | MEDLINE/PubMed |
spelling | pubmed-105622472023-10-11 Clinical Effectiveness of Artificial Disc Replacement in Comparison With Anterior Cervical Discectomy and Fusion in the Patients With Cervical Myelopathy: Systematic Review and Meta-analysis Lee, Jung Hwan Lee, Youn Joo Chang, Min Cheol Lee, Jun Ho Neurospine Original Article OBJECTIVE: Cervical myelopathy (CM) describes the compressive cervical spinal cord state, often accompanied by serious clinical condition, by herniated disc or hypertrophied spurs or ligament. Anterior cervical discectomy and fusion (ACDF) has been frequently employed as conventional surgical solution for this CM despite its inherent biomechanical handicap. Alternatively, an artificial disc replacement (ADR) preserves cervical motion while still decompressing the spinal canal and neural foramen. This analysis elaborated to clarify the potential benefits of ADR application to CM over ACDF from the conglomerated results of the past references. METHODS: A literature search was performed using MEDLINE, Embase, Cochrane review, and KMbase databases from the studies published until March 2023. Six studies (3 randomized controlled study [RCTs] and 3 non-RCTs) were included in a qualitative and quantitative synthesis. Data were extracted and analyzed using a random effects model to obtain effect size and its statistical significance. Quality assessment and evidence level were established in accordance with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. RESULTS: Among 6 studies, 2 studies showed that ADR group achieved significantly better clinical improvement than the ACDF group, while the rest 4 studies revealed no significant difference. A meta-analysis showed better clinical outcomes with or without statistical significance. The level of evidence was low because of inconsistency and imprecision. CONCLUSION: ADR was superior or at least, not inferior to ACDF in terms of functional recovery. However, its application to the CM patients is merely empowered with weak strength due to low level of evidence. Korean Spinal Neurosurgery Society 2023-09 2023-09-30 /pmc/articles/PMC10562247/ /pubmed/37798997 http://dx.doi.org/10.14245/ns.2346498.249 Text en Copyright © 2023 by the Korean Spinal Neurosurgery Society https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Lee, Jung Hwan Lee, Youn Joo Chang, Min Cheol Lee, Jun Ho Clinical Effectiveness of Artificial Disc Replacement in Comparison With Anterior Cervical Discectomy and Fusion in the Patients With Cervical Myelopathy: Systematic Review and Meta-analysis |
title | Clinical Effectiveness of Artificial Disc Replacement in Comparison With Anterior Cervical Discectomy and Fusion in the Patients With Cervical Myelopathy: Systematic Review and Meta-analysis |
title_full | Clinical Effectiveness of Artificial Disc Replacement in Comparison With Anterior Cervical Discectomy and Fusion in the Patients With Cervical Myelopathy: Systematic Review and Meta-analysis |
title_fullStr | Clinical Effectiveness of Artificial Disc Replacement in Comparison With Anterior Cervical Discectomy and Fusion in the Patients With Cervical Myelopathy: Systematic Review and Meta-analysis |
title_full_unstemmed | Clinical Effectiveness of Artificial Disc Replacement in Comparison With Anterior Cervical Discectomy and Fusion in the Patients With Cervical Myelopathy: Systematic Review and Meta-analysis |
title_short | Clinical Effectiveness of Artificial Disc Replacement in Comparison With Anterior Cervical Discectomy and Fusion in the Patients With Cervical Myelopathy: Systematic Review and Meta-analysis |
title_sort | clinical effectiveness of artificial disc replacement in comparison with anterior cervical discectomy and fusion in the patients with cervical myelopathy: systematic review and meta-analysis |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10562247/ https://www.ncbi.nlm.nih.gov/pubmed/37798997 http://dx.doi.org/10.14245/ns.2346498.249 |
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