Comparison of total disc replacement versus fusion for lumbar degenerative disc disease: a Meta-analysis of randomized controlled trials.

Liwei Yao; Tianyi Wang; Yang Liu; Shiqing Feng; Bin Zhang; Daigui Cao; Yanjun Zhang

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Comparison of total disc replacement versus fusion for lumbar degenerative disc disease: a Meta-analysis of randomized controlled trials.

Author: Liwei YAO ¹ ; Tianyi WANG ¹ ; Yang LIU ¹ ; Shiqing FENG ² ; Bin ZHANG ¹ ; Daigui CAO ¹ ; Yanjun ZHANG ¹
Author Information

1. Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin 300052, China.
2. Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin 300052, China. Email: fengsq321@sina.com.
Publication Type:Journal Article
MeSH: Humans; Intervertebral Disc Degeneration; surgery; Randomized Controlled Trials as Topic; Spinal Fusion; methods; Total Disc Replacement; Treatment Outcome
From: Chinese Journal of Surgery 2014;52(5):370-375
CountryChina
Language:Chinese
Abstract:
OBJECTIVETo compare the related clinical outcomes of total disc replacement (TDR) versus fusion in management of lumbar degenerative disc disease (LDDD)and provide available basis for choice of surgical procedure.
METHODSComputer systematically researched PubMed,EMBase, COCHRANE Library, CBMWin, CNKI, VIP databases for randomized controlled trials comparing TDR and fusion for LDDD. Data were searched until October 2013. The available statistical data was extracted after methodological assessment. The statistical soft RevMan 5.1 was used to analyze the results.
RESULTSTotal 1 658 cases of patients in 6 studies were conducted, including 543 cases of fusion and 1 115 cases of TDR. The results of Meta-analysis showed that TDR was superior to fusion in term of visual analogue scale (VAS) (OR = -3.33, 95%CI:-5.94--0.71, P = 0.01) , Oswestry disability index (ODI) (OR = -5.21, 95%CI:-7.51--2.92, P = 0.00) , complication (OR = 0.45, 95%CI:0.21-0.95, P = 0.04) . There were no statistically difference regarding operating time, blood loss and reoperation (P > 0.05). However, there was no difference in term of complication in two-year and five-year sub-analysis.
CONCLUSIONRegardless TDR may be more effective comparable to lumbar fusion at the immediate postoperative time, vigorous evidence is still requisite to certify the result in long-term follow-up.