{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T11:15:07Z","timestamp":1793704507766,"version":"4.5.1"},"reference-count":43,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2018,8,28]],"date-time":"2018-08-28T00:00:00Z","timestamp":1535414400000},"content-version":"vor","delay-in-days":27,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100010041","name":"Tianjin Science and Technology Committee","doi-asserted-by":"publisher","award":["16KG158"],"award-info":[{"award-number":["16KG158"]}],"id":[{"id":"10.13039\/501100010041","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2018,8]]},"abstract":"<jats:p>The purpose of this meta\u2010analysis was to explore whether cervical disc arthroplasty (CDA) was superior to anterior cervical discectomy and fusion (ACDF) in reducing secondary surgery. PubMed, EMBASE, and the Cochrane Library databases were systematically searched. Outcomes were reported as relative risk (<jats:italic>RR<\/jats:italic>) with the corresponding 95% confidence interval (<jats:italic>CI<\/jats:italic>). The pooled data was calculated using a random\u2010effect model. We also used the trial sequential analysis (TSA) to further verify our results and obtain more moderate estimates. Twenty\u2010one studies with 4208 patients were included in this meta\u2010analysis. The results indicated that compared with ACDF, CDA had fewer frequency of secondary surgery at the index level (<jats:italic>RR<\/jats:italic>, 0.47; 95%<jats:italic>CI<\/jats:italic>, 0.36\u20130.63; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05) and adjacent level (<jats:italic>RR<\/jats:italic>, 0.48; 95%<jats:italic>CI<\/jats:italic>, 0.36\u20130.65; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05), and the differences were statistically significant. In addition, in terms of the overall frequency of secondary surgery at the index and adjacent level, CDA was also significantly superior to ACDF (<jats:italic>RR<\/jats:italic>, 0.49; 95%<jats:italic>CI<\/jats:italic>, 0.41\u20130.60; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05). TSA demonstrated that adequate and decisive evidence had been established. Regarding the frequency of secondary surgery, CDA was significantly superior to ACDF. It was supposed that CDA may be a better surgical intervention to reduce the rate of secondary surgery for patients with cervical degenerative disc disease.<\/jats:p>","DOI":"10.1111\/os.12401","type":"journal-article","created":{"date-parts":[[2018,8,30]],"date-time":"2018-08-30T02:08:42Z","timestamp":1535594922000},"page":"181-191","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Secondary Surgery after Cervical Disc Arthroplasty versus Fusion for Cervical Degenerative Disc Disease: A Meta\u2010analysis with Trial Sequential Analysis"],"prefix":"10.1111","volume":"10","author":[{"given":"Ru\u2010sen","family":"Zhu","sequence":"first","affiliation":[{"name":"Department of Spine Surgery Tianjin Union Medical Center  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shun\u2010li","family":"Kan","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery Tianjin Union 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