This document summarizes a literature review comparing cervical fusion (ACDF) to disc replacement (TDR) for treating cervical disc disease. The review searched Medline, Embase, and Scopus databases and identified 37 randomized controlled trials and 16 meta-analyses of RCTs. Ten RCTs were analyzed in more depth based on factors like blinding, sample size, and recent publication. The conclusion is that TDR has better outcomes in terms of neck pain, cervical range of motion, and reoperation rates, while ACDF has a shorter operative time. TDR may also have advantages for arm pain, disability, quality of life, and dysphagia.

1. EBS
Salem Al-Dwairy
Spine fellow: Macquarie
Neurosurgery.
Macquarie university.
September, 2015

2. • 55years old.
• Neck pain + severe left arm pain
for three months.
• Not responding to conservative
treatment.
ACDF Vs TDR.

3. 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.

4. Data bases:
• Medline.
• Embase.
• Scopus.

5. Medline

6. Medline

9. Embase

10. Scopus
• Cervical
• fusion or arthrodesis or ACDF .
• "disc replacement" or "disc arthroplasty" or TDR.
• randomi*ed or RCT or RCCT.

12. Medline 37 Embase 22 Scopus 146
205
Non RCTs
TDR or ACDF alone
Duplicates
< 2 years follow-up
Cost effectiveness/economic analysis
Biomechanical comparison
Non-English Journals
Non-comparative
Bone graft studies
Non-human
Lumbar spine
Hybrid surgery
Surgical technique
TDR after ACDF
??? ACDF/TDR Vs THR
37 RCT + 16 met analysis of RCT
Excluded
152

14. Met analyses

15. 10 RCTs
• Blinding.
• Sample size.
• Recent studies.
• ? Funding.
• Common to met recent analysis.

16. 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.

17. Contribution to knowledge