Cervical radiculopathy: is a prosthesis preferred over fusion surgery? A systematic review
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ORIGINAL ARTICLE
Cervical radiculopathy: is a prosthesis preferred over fusion surgery? A systematic review Caroline M. W. Goedmakers1 · Tessa Janssen1 · Xiaoyu Yang1 · Mark P. Arts2 · Ronald H. M. A. Bartels3 · Carmen L. A. Vleggeert‑Lankamp1 Received: 14 February 2019 / Revised: 17 July 2019 / Accepted: 5 October 2019 © The Author(s) 2019
Abstract Background Meta-analyses on the comparison between fusion and prosthesis in the treatment of cervical radiculopathy mainly analyse studies including mixed patient populations: patients with radiculopathy with and without myelopathy. The outcome for patients with myelopathy is different compared to those without. Furthermore, apart from decompression of the spinal cord, restriction of motion is one of the cornerstones of the surgical treatment of spondylotic myelopathy. From this point of view, the results for arthroplasty might be suboptimal for this category of patients. Comparing clinical outcome in patients exclusively suffering from radiculopathy is therefore a more valid method to compare the true clinical effect of the prosthesis to that of fusion surgery. Aim The objective of this study was to compare clinical outcome of cervical arthroplasty (ACDA) to the clinical outcome of fusion (ACDF) after anterior cervical discectomy in patients exclusively suffering from radiculopathy, and to evaluate differences with mixed patient populations. Methods A literature search was completed in PubMed, EMBASE, Web of Science, COCHRANE, CENTRAL and CINAHL using a sensitive search strategy. Studies were selected by predefined selection criteria (i.a.) patients exclusively suffering from cervical radiculopathy), and risk of bias was assessed using a validated Cochrane Checklist adjusted for this purpose. An additional overview of results was added from articles considering a mix of patients suffering from myelopathy with or without radiculopathy. Results Eight studies were included that exclusively compared intervertebral devices in radiculopathy patients. Additionally, 29 articles concerning patients with myelopathy with or without radiculopathy were studied in a separate results table. All articles showed intermediate to high risk of bias. There was neither a difference in decrease in mean NDI score between the prosthesis (20.6 points) and the fusion (20.3 points) group, nor was there a clinically important difference in neck pain (VAS). Comparing these data to the mixed population data demonstrated comparable mean values, except for the 2-year follow-up NDI values in the prosthesis group: mixed group patients that received a prosthesis reported a mean NDI score Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00586-019-06175-y) contains supplementary material, which is available to authorized users. * Caroline M. W. Goedmakers [email protected] Tessa Janssen [email protected] Xiaoyu Yang [email protected] Mark P. Arts [email protected] Ronald H. M. A. Bartels [email protected]
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Department of
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