# Anterior Cervical Discectomy and Fusion Versus Cervical Disc Arthroplasty in Patients With Myelopathy and Radiculopathy: A Systematic Review and Meta-Analysis

## TL;DR

This study compares two surgical treatments for cervical spine issues and finds that one method provides better pain relief and fewer complications.

## Contribution

A meta-analysis comparing clinical outcomes of cervical disc arthroplasty versus fusion surgery for cervical degenerative disease.

## Key findings

- Cervical disc arthroplasty (CDA) showed better neck and arm pain reduction compared to ACDF.
- CDA significantly reduced the risk of adjacent segment disease and reoperation compared to ACDF.
- The study found no evidence of publication bias in the analyzed randomized controlled trials.

## Abstract

Cervical disc arthroplasty (CDA), which preserves motion, has emerged as a viable alternative to anterior cervical discectomy and fusion (ACDF) for treating individuals suffering from cervical degenerative disc disease. The present meta-analysis was undertaken to assess both clinical and radiographic results comparing CDA against ACDF. A systematic review of randomized controlled trials (RCTs) was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The analysis examined Neck Disability Index (NDI), Visual Analog Scale (VAS) measurements for cervical and upper extremity pain, frequencies of revision surgery, and adjacent segment disease (ASD). Random-effects models calculated pooled effect estimates. The I² statistic quantified heterogeneity, while funnel plot examination and Egger's test evaluated publication bias. The analysis incorporated 11 RCTs encompassing 2,537 patients. CDA demonstrated significant NDI improvement (standard mean difference (SMD) = -0.54, 95% CI: -1.00 to -0.08, p = 0.02, I² = 89%), neck pain reduction (SMD = -0.58, p = 0.004, I² = 86%), and arm pain alleviation (SMD = -0.44, p = 0.006, I² = 76%) relative to ACDF. Reoperation frequencies decreased with CDA (OR = 0.40, p = 0.0004, I² = 70%), alongside substantially diminished ASD risk (OR = 0.36, p < 0.00001, I² = 67%). Publication bias remained undetected. In conclusion, compared to ACDF, CDA provides superior outcomes in pain relief, functional recovery, and prevention of reoperation and ASD. CDA should be considered a preferred option in suitable patients.