Spinal Fusion versus Disc Replacement for Single-Level Cervical Degenerative Disc Disease: A Systematic Review

Abstract

Introduction: For cervical degenerative disc disease causing radiculopathy or myelopathy, both anterior cervical discectomy and fusion (ACDF) and cervical disc replacement (CDR) are surgical options. CDR was developed to preserve motion. This review compares their outcomes.

Methods: A search of MEDLINE and Embase was conducted for RCTs comparing single-level ACDF to CDR. Primary outcomes were Neck Disability Index (NDI) scores, neurological success, and rates of secondary surgery.

Results: The meta-analysis of numerous RCTs showed that both ACDF and CDR resulted in significant and comparable improvements in NDI scores and neurological success. However, CDR was associated with a significantly lower rate of secondary surgical procedures at both the index and adjacent levels at long-term follow-up.

Discussion: CDR effectively treats the primary pathology while preserving segmental motion, which appears to reduce the stress on adjacent spinal levels and lower the need for future surgery.

Conclusion: Cervical disc replacement is superior to spinal fusion in reducing the rates of subsequent surgery for single-level cervical degenerative disc disease.