{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T18:35:12Z","timestamp":1792694112244,"version":"4.5.0"},"reference-count":52,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2019,12,21]],"date-time":"2019-12-21T00:00:00Z","timestamp":1576886400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2020,2]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Whether cervical disc arthroplasty (CDA) is superior to anterior cervical discectomy and fusion (ACDF) remains controversial, especially in relation to long\u2010term results. The present study aimed to evaluate the long\u2010term safety and efficiency of CDA and ACDF for cervical disc disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed this study according to the Cochrane methodology. An extensive search was undertaken in PubMed, Embase, and Cochrane databases up to 1 June 2019 using the following key words: \u201canterior cervical fusion,\u201d \u201carthroplasty,\u201d \u201creplacement\u201d and \u201cartificial disc\u201d. RevMan 5.3 (Cochrane, London, UK) was used to analyze data. Safety and efficiency outcome measures included the success rate, functional outcome measures, adverse events (AE), adjacent segment degeneration (ASD), secondary surgery, and patients\u2019 satisfaction and recommendation rates. The OR and MD with 95% confidence interval (CI) were used to evaluate discontinuous and continuous variables, respectively. The statistically significant level was set at <jats:italic>P<\/jats:italic> &lt;\u20090.05.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 11 randomized controlled trials with 3505 patients (CDA\/ACDF: 1913\/1592) were included in this meta\u2010analysis. Compared with ACDF, CDA achieved significantly higher overall success (2.10, 95% <jats:italic>CI<\/jats:italic> [1.70, 2.59]), neck disability index (NDI) success (1.73, 95% <jats:italic>CI<\/jats:italic> [1.37, 2.18]), neurological success (1.65, 95% <jats:italic>CI<\/jats:italic> [1.24, 2.20]), patients\u2019 satisfaction (2.14, 95% <jats:italic>CI<\/jats:italic> [1.50, 3.05]), and patients\u2019 recommendation rates (3.23, 95% <jats:italic>CI<\/jats:italic> [1.79, 5.80]). Functional outcome measures such as visual analog score neck pain (\u22125.50, 95% <jats:italic>CI<\/jats:italic> [\u22128.49, \u22122.52]) and arm pain (\u22123.78, 95% <jats:italic>CI<\/jats:italic> [\u22127.04, \u22120.53]), the Short Form\u201036 physical component score (SF\u201036 PCS) (1.93, 95% <jats:italic>CI<\/jats:italic> [0.53, 3.32]), and the Short Form\u201036 mental component score (SF\u201036 MCS) (2.62, 95% <jats:italic>CI<\/jats:italic> [0.95, 4.29]), revealed superiority in the CDA group. CDA also achieved a significantly lower rate of symptomatic ASD (0.46, 95% <jats:italic>CI<\/jats:italic> [0.34, 0.63]), total secondary surgery (0.50, 95% <jats:italic>CI<\/jats:italic> [0.29, 0.87]), secondary surgery at the index level (0.46, 95% <jats:italic>CI<\/jats:italic> [0.29, 0.74]), and secondary surgery at the adjacent level (0.37, 95% <jats:italic>CI<\/jats:italic> [0.28, 0.49]). However, no significant difference was found in radiological success (1.35, 95% <jats:italic>CI<\/jats:italic> [0.88, 2.08]), NDI score (\u22122.88, 95% <jats:italic>CI<\/jats:italic> [\u22125.93, 0.17]), total reported AE (1.14, 95% <jats:italic>CI<\/jats:italic> [0.92, 1.42]), serious AE (0.89, 95% <jats:italic>CI<\/jats:italic> [0.71, 1.11]), device\/surgery\u2010related AE (0.90, 95% <jats:italic>CI<\/jats:italic> [0.68, 1.18]), radiological superior ASD (0.63, 95% <jats:italic>CI<\/jats:italic> [0.28, 1.43]), inferior ASD (0.45, 95% <jats:italic>CI<\/jats:italic> [0.19, 1.11]), and work status (1.33, 95% <jats:italic>CI<\/jats:italic> [0.78, 2.25]). Furthermore, subgroup analysis showed different results between US and non\u2010US groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our study provided further evidence that compared to ACDF, CDA had a higher long\u2010term clinical success rate and better functional outcome measurements, and resulted in less symptomatic ASD and fewer secondary surgeries. However, worldwide multicenter RCT with long\u2010term follow up are still needed for further evaluation in the future.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.12585","type":"journal-article","created":{"date-parts":[[2019,12,21]],"date-time":"2019-12-21T10:42:33Z","timestamp":1576924953000},"page":"16-30","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":84,"title":["Long\u2010term Results Comparing Cervical Disc Arthroplasty to Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta\u2010Analysis of Randomized Controlled Trials"],"prefix":"10.1111","volume":"12","author":[{"given":"Qiao\u2010li","family":"Wang","sequence":"first","affiliation":[{"name":"ICU Center The Second Xiangya Hospital of Central South University  Changsha 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