ABSTRACT
Study design: Systematic review.
Clinical questions: What are the rates and causes of subsequent surgeries? What is the long-term complication
rates following cervical artificial disc replacement (C-ADR)? How do these rates change
over time?
Methods: A systematic review was undertaken for articles published up to October 2011. Electronic
databases and reference lists of key articles were searched to identify comparative
and non-comparative studies reporting long-term (≥ 48 months) complications of C-ADR.
Two independent reviewers assessed the strength of evidence using the GRADE criteria
and disagreements were resolved by consensus.
Results: Two RCTs reporting outcomes following C-ADR (Bryan disc, Prestige disc) versus anterior
cervical discectomy and fusion (ACDF) at follow-ups of 4 to 5 years were found; five
case series reporting outcomes following C-ADR at follow-ups of 4 to 8 years were
identified. Secondary surgery rates were similar or slightly lower following C-ADR
compared with fusion at 4 to 5 years postoperatively. In one small subset of an RCT,
rates of adjacent disc heterotopic ossification were lower in C-ADR patients than
in those treated with fusion. Rates of other adverse events were similar between treatment
groups.
Conclusions: There is low evidence on the long-term safety outcomes following C-ADR. Additional
comparative studies with follow-up of at least 4 years are needed to fully understand
the long-term safety outcomes of C-ADR compared with fusion.
