Single or double-level anterior interbody fusion techniques for cervical degenerative disc disease

Jacobs WCH, Anderson PG, van Limbeek J, Willems PC, Pavlov P

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Summary

Conservative anterior cervical fusion techniques seem to be as effective as more sophisticated techniques that use allografts, plates or cages.

For patients with degenerative disc disease at one or two cervical levels, discectomy (removal of the disc) alone results in a shorter hospital stay with a similar rate of fusion of the adjoining vertebrae than surgical techniques that use autograft (using your own bone for a graft). Surgical techniques that use autograft provide a better chance for fusion than those using a cage for additional stability, although the evidence is weak.

This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2008 Issue 3, Copyright © 2008 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This record should be cited as: Jacobs WCH, Anderson PG, van Limbeek J, Willems PC, Pavlov P. Single or double-level anterior interbody fusion techniques for cervical degenerative disc disease. Cochrane Database of Systematic Reviews 2004, Issue 4. Art. No.: CD004958. DOI: 10.1002/14651858.CD004958

This version first published online: October 18. 2004

Abstract

Background

The number of surgical techniques for decompression and solid interbody fusion as a treatment for cervical spondylosis has increased rapidly, but the rationale for the choice between different techniques is unclear.

Objectives

The goal of this study was to determine which method of anterior cervical interbody fusion at a single or double-level provides the best clinical and radiological outcome in patients with degenerative disc disease.

Search strategy

Studies were identified with a computer-assisted search of electronic databases in the Cochrane Central Register of Controlled Trials (Issue 1, 2004), MEDLINE (1966 to 2004), EMBASE (1980 to 2004), and Current Contents (1996 to 2004). We also searched references of selected articles.

Selection criteria

With the aid of a checklist, two authors independently screened the identified references. Consensus was reached through negotiation. A third author was consulted if consensus could not be reached. Inclusion criteria included: articles were reports of randomised comparative studies; treatments compared anterior cervical decompression and interbody fusion techniques, participants were individuals scheduled for surgery for a chronic (longer than 12 weeks) diagnosis of degenerative disc disease.

Data collection and analysis

Methodological quality was assessed independently by two authors, using the van Tulder list of criteria. With the aid of a data extraction form, data was extracted independently by two authors on group characteristics, intervention details and outcome measures.

Main results

Fourteen studies with 939 patients evaluated three comparisons of different fusion techniques. From these comparisons it appears that discectomy alone has a shorter operation time, hospital stay, and post-operative absence from work than discectomy with fusion, while there is no statistical difference for pain relief and rate of fusion. It also appears that fusion techniques that use autograft give a better chance for fusion than interbody fusion techniques that use a cage, but other outcome variables could not be combined.

Authors' conclusions

The low quality of the trials prohibits extensive conclusions from this review. More studies with better methodology and reporting are needed. There should be a more general agreement between researchers on which outcome parameters should be used in the evaluation of anterior cervical fusion procedures.

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