Adjacent segment degeneration and disease following cervical arthroplasty: a systematic review and meta-analysis.
Spine J. 2015 Oct 26;
Authors: Shriver MF, Lubelski D, Sharma AM, Steinmetz MP, Benzel EC, Mroz TE
BACKGROUND CONTEXT: Cervical arthroplasty is an increasingly popular alternative for the treatment of cervical radiculopathy and myelopathy. This technique preserves motion at the index and adjacent disc levels, avoiding the restraints of fusion and potentially minimizing adjacent segment pathology onset during the postoperative period.
PURPOSE: To identify all prospective studies reporting adjacent segment pathology rates for cervical arthroplasty.
STUDY DESIGN/SETTING: Systematic review and meta-analysis.
PATIENT SAMPLE: Studies reporting adjacent segment degeneration (ASDegeneration) and/or disease (ASDisease) rates in patients who underwent cervical arthroplasty.
OUTCOME MEASURES: Outcomes of interest included reported ASDegeneration and ASDisease events after cervical arthroplasty.
METHODS: We conducted a MEDLINE, SCOPUS and Web of Science search for studies reporting ASDegeneration or ASDisease following cervical arthroplasty. A meta-analysis was performed to calculate effect summary values, 95% confidence intervals (CIs), Q values and I(2) values. Forest plots were constructed for each analysis group.
RESULTS: Of the 1,891 retrieved articles, 32 met inclusion criteria. The patient incidence of ASDegeneration and ASDisease was 8.3% (95% CI 3.8% – 12.7%) and 0.9% (95% CI 0.1% – 1.7%), respectively. The rate of ASDegeneration and ASDisease at individual levels was 10.5% (95% CI 6.1% – 14.9%) and 0.2% (95% CI -0.1% – 0.5%), respectively. Studies following patients for 12-24 months reported a 5.1% (95% CI 2.1% – 8.1%) incidence of ASDegeneration and 0.2% (95% CI 0.1% – 0.2%) incidence of ASDisease. Conversely, studies following patients for greater than 24 months reported a 16.6% (5.8% – 27.4%) incidence of ASDegeneration and 2.6% (95% CI 1.0% – 4.2%) of ASDisease. This identified a statistically significant increase in ASDisease diagnosis with lengthier follow-up. Additionally, 1- and 2-level procedures resulted in a 7.4% (95% CI 3.3% – 11.4%) and 15.6% (95 CI -9.2% – 40.4%) incidence of ASDegeneration, respectively. While there was an 8.2% increase in ASDegeneration following 2-level operations (relative to 1-level), it did not reach statistical significance. We were unable to analyze ASDisease incidence following 2-level arthroplasty (too few cases), but 1-level operations resulted in an ASDisease incidence of 0.8% (95% CI 0.1% – 1.5%).
CONCLUSIONS: This review represents a comprehensive estimation of the actual incidence of ASDegeneration and ASDisease across a heterogeneous group of surgeons, patients and arthroplasty techniques. Our investigation should serve as a framework for individual surgeons to understand the impact of various cervical arthroplasty techniques, follow-up duration and surgical levels on the incidence of ASDegeneration and ASDisease during the postoperative period.
PMID: 26515401 [PubMed – as supplied by publisher]