Systematic review and Meta-analysis: Anterior Cervical Discectomy and Fusion versus Cervical Disc Replacement in Cervical Disc Herniation

Abstract

Background: Cervical disc herniation is a common cause of neck pain in adults. The severity of the disease can range from mild to severe. The prevalence of cervical disc herniation increases with age for both men and women and is most common in people in their 3rd to 5th decades of life. It occurs more frequently in females, accounting for more than 60% of cases. For both sexes, the most frequently diagnosed patients were in the age group of 51 to 60. Anterior cervical discectomy and fusion (ACDF) was considered the ―gold standard‖ for management of cervical disc herniation. But in recent years, radiographic and clinical studies have shown that as time passes, the segments adjacent to the fused spinal segments become occasionally degenerated or unstable. ACDF involves removing the problematic disc completely and replacing it with a bone graft (or bone graft substitute) to allow the adjacent vertebrae to eventually fuse together. One of the main limitations of the ACDF surgery, is that it alters the original mechanical behavior of the spine at the expense of the activity of the fusion segment; and this leads to the changes of adjacent vertebral stress distribution and the movement patterns, resulting in biomechanical changes including stress concentration of adjacent segments, compensatory increase in activity, and even instability.