Cervical Disc Replacement versus Anterior Cervical Discectomy and Fusion for Single-Level Symptomatic Degenerative Disc Disease: A Meta-Analysis

Abstract

Introduction: For cervical radiculopathy or myelopathy refractory to conservative care, both anterior cervical discectomy and fusion (ACDF) and cervical disc replacement (CDR) are established surgical treatments. CDR aims to preserve motion, potentially reducing the risk of adjacent segment disease. This review compares the long-term outcomes of the two procedures.

Methods: A comprehensive search for RCTs was conducted, comparing single-level CDR with ACDF. Primary outcomes were Neck Disability Index (NDI) scores, neurological success rates, and the incidence of secondary surgery at the index or adjacent levels.

Results: The meta-analysis of multiple RCTs with long-term follow-up showed that both CDR and ACDF provided significant and comparable improvements in NDI scores and neurological success. However, the CDR group had a statistically significant lower rate of subsequent surgical intervention at an adjacent cervical level. Motion at the index level was preserved in the CDR group.

Discussion: The primary advantage of CDR over the gold-standard ACDF appears to be its effect on adjacent spinal segments. By preserving motion, CDR may reduce the biomechanical stress on adjacent discs, leading to a lower need for future spine surgery.

Conclusion: Cervical disc replacement is superior to ACDF in reducing the risk of subsequent surgery at adjacent levels for single-level cervical degenerative disc disease.