EBSSalem Al-Dwairy

Spine fellow: Macquarie Neurosurgery.Macquarie university.

September, 2015

• 55years old.• Neck pain + severe left arm pain

for three months.• Not responding to conservative

treatment.

ACDF Vs TDR.

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.

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

Medline

Medline

Embase

Scopus

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

Medline 37 Embase 22 Scopus 146

205

Non RCTsTDR or ACDF aloneDuplicates< 2 years follow-upCost effectiveness/economic analysisBiomechanical comparisonNon-English JournalsNon-comparativeBone graft studiesNon-humanLumbar spineHybrid surgerySurgical techniqueTDR after ACDF??? ACDF/TDR Vs THR

37 RCT + 16 met analysis of RCT

Excluded 152

Met analyses

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

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.

Contribution to knowledge