Advanced meta-analyses comparing the three surgical techniques total disc replacement, anterior stand-alone fusion and circumferential fusion regarding pain, function and complications up to 3 years to treat lumbar degenerative disc disease.
Different fusion surgeries
Lumbar degenerative disc disease
Meta-analysis
Total disc replacement
Journal
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
ISSN: 1432-0932
Titre abrégé: Eur Spine J
Pays: Germany
ID NLM: 9301980
Informations de publication
Date de publication:
12 2021
12 2021
Historique:
received:
17
09
2020
accepted:
18
02
2021
revised:
12
01
2021
pubmed:
11
4
2021
medline:
1
2
2022
entrez:
10
4
2021
Statut:
ppublish
Résumé
The purpose of our meta-analyses is to find the most appropriate surgical technique treating lumbar degenerative disc disease (DDD). Spinal fusion is the conventional treatment for lumbar DDD. Total disc replacement (TDR) has been developed to avoid negative effects of fusions by preserving functionality. To our knowledge, there is no evaluation comparing meta-analytically the clinical results of three different surgical techniques with same inclusion and exclusion criteria for treating DDD. The surgical techniques TDR, anterior lumbar interbody fusion (ALIF) and circumferential fusion (CFF) are pairwise meta-analytically compared. Primary outcomes are pain measured by the Visual Analogue Scale (VAS) and function measured by the Oswestry Disability Index (ODI). Secondary outcomes are the mean number of complications per case (MNOC) at surgery and follow-up and the overall MNOC. In our systematic search, we found finally six prospective studies with the minimum follow-up of two years: four randomized controlled trials and two cohort studies. In VAS and ODI, TDR is proved to be superior to ALIF and CCF (p < 0.05), whereat ALIF is more effective than CFF without statistical significance. CFF presents the best result in complications with the lowest overall MNOC (0.1), followed by TDR (1.2) and ALIF (1.5). According to our meta-analyses, we regard TDR to be the most appropriate surgical technique treating DDD, followed by ALIF. Further studies with a longer follow-up are needed using the same methodical approach to strengthen the VAS and ODI results and to explain the discrepant result to complications.
Identifiants
pubmed: 33837832
doi: 10.1007/s00586-021-06784-6
pii: 10.1007/s00586-021-06784-6
doi:
Types de publication
Journal Article
Meta-Analysis
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
3688-3701Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
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