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Adjacent Segment Pathology Following Cervical Motion Sparing Procedures or Devices Compared to Fusion Surgery: A Systematic Review.

TitelAdjacent Segment Pathology Following Cervical Motion Sparing Procedures or Devices Compared to Fusion Surgery: A Systematic Review.
Publication TypeJournal Article
Year of Publication2012
AuthorsHarrod, CC, Hilibrand, AS, Fischer, DJ, Skelly, AC
JournalSpine
Date Published2012 Aug 6
ISSN1528-1159
SchlüsselwörterBandscheibenprothese, wirbelsaeulenversteifung
Abstract ABSTRACT: Study Design. Systematic Review.Objective. To critically review and summarize the literature comparing motion preservation devices to fusion in the cervical spine to determine if the use of these devices decreases the development of radiographic (RASP) or clinical adjacent segment pathology (CASP) compared to fusion.Summary of Background Data. Historically, surgical treatment of symptomatic cervical disk disease presenting as radiculopathy and/or myelopathy with anterior cervical decompression and fusion has yielded excellent results. Controversy remains whether RASP and CASP requiring treatment is due to fusion-altered biomechanics and kinematics versus natural history.Methods. We conducted a systematic search in Medline and the Cochrane Collaboration Library for literature published through February 2012 on human randomized control trials or cohort studies published in the English language containing abstracts to answer the following key questions: (1) Is there evidence that total disc replacement (TDR) is associated with a lower risk of RASP or CASP compared to fusion? (2) Is there evidence that other procedures which do not involve arthrodesis or other motion-sparing devices are associated with a lower risk of RASP or CASP compared to fusion? (3) Is one type of motion preservation device or procedure associated with a lower risk of RASP or CASP compared with others?Results. The initial literature search yielded 276 citations, of which 73 unique, potentially relevant citations which were evaluated against the inclusion/exclusion criteria set a priori. A total of 14 studies were selected for inclusion. For question one, RASP was variably reported in studies that compared total disc replacement (TDR) to anterior cervical decompression and fusion (ACDF), and risk differences for re-operation due to CASP ranged from 1.0-4.8%, with no statistically significant differences between groups. For question two, no studies comparing motion preservation devices to ACDF met our inclusion criteria. For question three, one study comparing motion sparing devices found the risk of RASP to be similar between groups.Conclusion. A paucity of high quality literature comparing motion-preserving devices or treatment methods to fusion or other motion-preserving techniques or devices (with RASP and/or CASP as an outcome using consistent definitions) exists. Independently funded, blinded long term follow-up prospective studies would be able to delineate the true effects in regards to incidence of RASP and CASPand treatment of CASP.
DOI10.1097/BRS.0b013e31826cb2d6
Alternate JournalSpine
Full Text
PubMed ID22872222
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