{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T19:36:14Z","timestamp":1792179374205,"version":"4.4.0"},"reference-count":146,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,29]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Anterior cervical discectomy and fusion (ACDF) is an established treatment for cervical degenerative disc disease; however, the procedure can cause loss of cervical spine range of motion and potentially accelerate adjacent segment degeneration. Cervical disc arthroplasty (CDA) seeks to preserve native motion of the cervical spine, which can theoretically reduce the incidence of adjacent level degeneration. The literature regarding the relative efficacy of ACDF versus CDA remains inconsistent. In this study, the authors investigate the difference in outcomes between ACDF and CDA and identify factors contributing to the heterogeneity in the literature.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n \n The Ovid, Embase, Scopus, Cochrane, and\n ClinicalTrials.gov<\/jats:ext-link>\n databases were systematically searched from inception to September 5, 2023, for randomized controlled trials (RCTs) comparing ACDF and CDA for degenerative disc disease. Studies were extracted by two authors and verified by a third. Random-effects meta-analysis was performed. The primary outcome was the difference in clinical outcomes between the two surgical groups. The secondary outcomes were the differences in radiological outcomes, surgical characteristics, complication rates, and hospital lengths of stay. The study was registered with the International Prospective Register of Systematic Reviews (PROSPERO; registration no. CRD42023469204) and adhered to the PRISMA guidelines.\n <\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n From 584 articles uploaded to the Covidence platform for screening, 35 studies derived from 25 RCTs were included in this systematic review and meta-analysis. A total of 4530 patients were treated with ACDF (2081) and CDA (2449). Forty-six percent of the patients (2063) were male, and the mean age of the study cohort was 45 \u00b1 3 years. In terms of the primary outcome, CDA showed higher rates of neurological and overall success. Regarding the secondary outcomes, CDA demonstrated a significantly lower rate of adjacent level disease, higher rate of heterotopic ossification, and greater range of motion at the operated level. Additionally, CDA had lower rates of reoperation but significantly longer operative times than ACDF. The inclusion of myelopathic patients and variations in follow-up between the surgical groups contributed to the observed effect heterogeneity among studies.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n In this study, CDA showed comparable or potentially greater success in overall and neurological outcomes, along with a lower incidence of adjacent level degeneration and reoperation rates but longer operative times.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2025.4.spine241277","type":"journal-article","created":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T14:34:52Z","timestamp":1757687692000},"page":"703-716","source":"Crossref","is-referenced-by-count":10,"title":["Randomized controlled trials comparing cervical disc arthroplasty and anterior cervical discectomy and fusion outcomes in degenerative spine disease: a systematic review and meta-analysis"],"prefix":"10.3171","volume":"43","author":[{"given":"Salim","family":"Yakdan","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Washington University, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Braeden","family":"Benedict","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Washington University, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Botterbush","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Washington University, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adhya","family":"Lagisetty","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Washington University, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Irfan","family":"Kaleem","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Washington University, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Alessio","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Washington University, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Hardi","sequence":"additional","affiliation":[{"name":"Becker Medical Library, Washington University, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saad","family":"Javeed","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Washington University, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel A.","family":"Ruiz-Cardozo","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Washington University, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander T.","family":"Yahanda","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Washington University, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Washington University, St. Louis, Missouri; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad","family":"Bydon","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilson Z.","family":"Ray","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Washington University, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob K.","family":"Greenberg","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Washington University, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"6","key":"b1","series-title":"J Neurosurg","first-page":"602","article-title":"The anterior approach for removal of ruptured cervical disks","volume":"15","author":"Cloward RB","year":"1958","unstructured":"Cloward RB. 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J Neurosurg Spine. 2006;4(2):98\u2013105."},{"issue":"3","key":"b14","series-title":"J Long Term Eff Med Implants","first-page":"229","article-title":"Segmental kinematics and adjacent level degeneration following disc replacement versus fusion: RCT with three years of follow-up","volume":"17","author":"Nabhan A","year":"2007","unstructured":"Nabhan A, Steudel WI, Nabhan A, Pape D, Ishak B. Segmental kinematics and adjacent level degeneration following disc replacement versus fusion: RCT with three years of follow-up. J Long Term Eff Med Implants. 2007;17(3):229\u2013236."},{"issue":"12","key":"b15","series-title":"Spine J","first-page":"1043","article-title":"Total disc arthroplasty does not affect the incidence of adjacent segment degeneration in cervical spine: results of 93 patients in three prospective randomized clinical trials","volume":"10","author":"Jawahar A","year":"2010","unstructured":"Jawahar A, Cavanaugh DA, Kerr EJIII, Birdsong EM, Nunley PD. 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Comparative study of artificial cervical disc replacement and anterior cervical discectomy\/fusion in the treatment of cervical spondylotic myelopathy. Int J Clin Exp Med. 2019;12(8):10597\u201310604."},{"issue":"12","key":"b33","series-title":"Clin Orthop Relat Res","first-page":"3408","article-title":"Superiority of the Bryan\u00ae disc prosthesis for cervical myelopathy: a randomized study with 3-year followup","volume":"469","author":"Cheng L","year":"2011","unstructured":"Cheng L, Nie L, Li M, Huo Y, Pan X. Superiority of the Bryan\u00ae disc prosthesis for cervical myelopathy: a randomized study with 3-year followup. 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J Neurosurg Spine. 2013;19(5):532\u2013545."},{"issue":"12","key":"b36","series-title":"Acta Neurochir (Wien)","first-page":"2359","article-title":"Cervical sagittal alignment after different anterior discectomy procedures for single-level cervical degenerative disc disease: randomized controlled trial","volume":"159","author":"Donk RD","year":"2017","unstructured":"Donk RD, Arnts H, Verhagen WIM, Groenewoud H, Verbeek A, Bartels R. Cervical sagittal alignment after different anterior discectomy procedures for single-level cervical degenerative disc disease: randomized controlled trial. Acta Neurochir (Wien). 2017;159(12):2359\u20132365."},{"issue":"8","key":"b37","series-title":"PLoS One","first-page":"e0183603","article-title":"What\u2019s the best surgical treatment for patients with cervical radiculopathy due to single-level degenerative disease? A randomized controlled trial","volume":"12","author":"Donk RD","year":"2017","unstructured":"Donk RD, Verbeek ALM, Verhagen WIM, Groenewoud H, Hosman AJF, Bartels R. What\u2019s the best surgical treatment for patients with cervical radiculopathy due to single-level degenerative disease? A randomized controlled trial. PLoS One. 2017;12(8):e0183603."},{"issue":"4","key":"b38","series-title":"Sovrem Tekhnologii Med","first-page":"50","article-title":"Sagittal balance parameters after anterior cervical discectomy with spondylodesis and arthroplasty using endocarbon endoprosthesis: results of randomized study","volume":"14","author":"Eliseev AS","year":"2022","unstructured":"Eliseev AS, Bokov AE, Mlyavykh SG. Sagittal balance parameters after anterior cervical discectomy with spondylodesis and arthroplasty using endocarbon endoprosthesis: results of randomized study. Sovrem Tekhnologii Med. 2022;14(4):50\u201357."},{"issue":"6","key":"b39","series-title":"J Neurosurg Spine","first-page":"653","article-title":"Cervical disc arthroplasty with the Prestige LP disc versus anterior cervical discectomy and fusion, at 2 levels: results of a prospective, multicenter randomized controlled clinical trial at 24 months","volume":"26","author":"Gornet MF","year":"2017","unstructured":"Gornet MF, Lanman TH, Burkus JK, Cervical disc arthroplasty with the Prestige LP disc versus anterior cervical discectomy and fusion, at 2 levels: results of a prospective, multicenter randomized controlled clinical trial at 24 months. 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J Bone Joint Surg Am","first-page":"1738","article-title":"ProDisc-C total disc replacement versus anterior cervical discectomy and fusion for single-level symptomatic cervical disc disease: seven-year follow-up of the prospective randomized U.S","volume":"97","author":"Janssen ME","year":"2015","unstructured":"Janssen ME, Zigler JE, Spivak JM, Delamarter RB, Darden BV, Kopjar B. ProDisc-C total disc replacement versus anterior cervical discectomy and fusion for single-level symptomatic cervical disc disease: seven-year follow-up of the prospective randomized U.S. Food and Drug Administration investigational device exemption study. J Bone Joint Surg Am. 2015;97(21):1738\u20131747."},{"issue":"12","key":"b42","series-title":"J Pak Med Assoc","first-page":"1348","article-title":"Arthroplasty versus fusion for single-level cervical disc disease","volume":"64","author":"Karabag H","year":"2014","unstructured":"Karabag H, Cakmak E, Celik B, Iplikcioglu AC, Soran AF. Arthroplasty versus fusion for single-level cervical disc disease. J Pak Med Assoc. 2014;64(12):1348\u20131351."},{"issue":"15","key":"b43","series-title":"Spine (Phila Pa 1976)","first-page":"1171","article-title":"Adjacent segment motion after anterior cervical discectomy and fusion versus ProDisc-C cervical total disk arthroplasty: analysis from a randomized, controlled trial","volume":"36","author":"Kelly MP","year":"2011","unstructured":"Kelly MP, Mok JM, Frisch RF, Tay BK. Adjacent segment motion after anterior cervical discectomy and fusion versus ProDisc-C cervical total disk arthroplasty: analysis from a randomized, controlled trial. Spine (Phila Pa 1976). 2011;36(15):1171\u20131179."},{"issue":"5","key":"b44","series-title":"Eur Spine J","first-page":"1260","article-title":"ProDisc-C versus anterior cervical discectomy and fusion for the surgical treatment of symptomatic cervical disc disease: two-year outcomes of Asian prospective randomized controlled multicentre study","volume":"31","author":"Kumar N","year":"2022","unstructured":"Kumar N, Liu ZJ, Poon WS, ProDisc-C versus anterior cervical discectomy and fusion for the surgical treatment of symptomatic cervical disc disease: two-year outcomes of Asian prospective randomized controlled multicentre study. 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