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Factors that may affect outcome in cervical artificial disc replacement: a systematic review

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Abstract

Purpose

To identify the factors that may affect outcome in C-ADR and provide the pooled results of postoperative success rate of implanted segment range of motion (ROM), incidence of heterotopic ossification (HO), incidence of radiographic adjacent segment degeneration (r-ASD)/adjacent segment disease (ASD), and surgery rate for ASD.

Methods

We systematically searched in PubMed, Embase, Cochrane library and Web of knowledge from 2001 to May 2015. Two independent reviewers screened the primary records. Eleven questions regarding the effect of patient selection issues and radiographic parameters issues on outcome were posed previously. Studies addressing the framed questions were included for analysis.

Results

Twenty-two studies were included for the final analysis. Results showed that number of surgical level (single versus double-level) had no effect on primary clinical outcome and radiographic outcome, surgical level had no effect on clinical and radiographic outcome, and smoking habits had negative effect on clinical outcome. No evidence for the effect of patient’s age and pathology category (radiculopathy or myelopathy) on outcome was found. The overall success rate of ROM was 79.4 %. ROM of the implanted segment and cervical sagittal alignment had no effects on clinical outcome. The pooled incidences of grade 1–4 HO and grade 3–4 HO were 27.7 and 7.8 %, respectively. The pooled incidence of r-ASD and surgery rate for ASD were 42.4 and 3.8 %, respectively.

Conclusions

The available evidence showed that most of the pre-selected factors had no effect on outcome after C-ADR, and the ROM success rate, incidence of HO and r-ASD/ASD, and surgery rate for ASD are acceptable. There is a lack of evidence from RCTs for some factors.

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Author notes

    Authors and Affiliations

    1. Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China

      Jian Kang, Changgui Shi, Yifei Gu, Chengwei Yang & Rui Gao

    2. Department of Orthopedics, Jinan General Hospital of PLA, 25 Shifan Road, Jinan, 250031, China

      Jian Kang

    3. Department of Spine Surgery, Lanzhou General Hospital of PLA, 333 South Binhe Road, Lanzhou, 730050, China

      Chengwei Yang

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    1. Jian Kang
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    2. Changgui Shi
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    3. Yifei Gu
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    Corresponding author

    Correspondence to Rui Gao.

    Additional information

    C. Shi and J. Kang contributed equally to this work and should be considered as Co-first author.

    C. Yang and R. Gao contributed equally to this work and should be considered as Co-corresponding author.

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    Kang, J., Shi, C., Gu, Y. et al. Factors that may affect outcome in cervical artificial disc replacement: a systematic review. Eur Spine J 24, 2023–2032 (2015). https://doi.org/10.1007/s00586-015-4096-6

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    • DOI: https://doi.org/10.1007/s00586-015-4096-6

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