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EBSSalem Al-Dwairy
Spine fellow: Macquarie Neurosurgery.Macquarie university.
September, 2015
• 55years old.• Neck pain + severe left arm pain
for three months.• Not responding to conservative
treatment.
ACDF Vs TDR.
PICO: Fusion Vs disc replacement in patients with cervical disc disease.
• P: Patients with cervical disc disease.• I: Cervical fusion.• C: Disc replacement.• O: Treatment outcome.
Data bases:• Medline.• Embase.• Scopus.
Medline
Medline
Embase
Scopus
• Cervical • fusion or arthrodesis or ACDF .• "disc replacement" or "disc arthroplasty" or TDR.• randomi*ed or RCT or RCCT.
Medline 37 Embase 22 Scopus 146
205
Non RCTsTDR or ACDF aloneDuplicates< 2 years follow-upCost effectiveness/economic analysisBiomechanical comparisonNon-English JournalsNon-comparativeBone graft studiesNon-humanLumbar spineHybrid surgerySurgical techniqueTDR after ACDF??? ACDF/TDR Vs THR
37 RCT + 16 met analysis of RCT
Excluded 152
Met analyses
10 RCTs• Blinding.• Sample size.• Recent studies.• ? Funding.• Common to met recent analysis.
Conclusion • TDR has better outcome in term of: neck VAS, C spine ROM and
reoperation rate.• ACDF procedure have less operative time.• TDR might have better outcome in : NDI, arm VAS, SF 36 and
dysphagia.
Contribution to knowledge
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