COCHRANE IN CORR Cochrane in CORR 1 : Arthroplasty Versus Fusion in Single-level Cervical Degenerative Disc Disease Nathan Evaniew MD, Kim Madden Bsc, Mohit Bhandari MD, PhD, FRCSC Received: 14 August 2013 / Accepted: 4 September 2013 / Published online: 28 September 2013 Ó The Association of Bone and Joint Surgeons1 2013 Importance of the Topic Cervical spondylosis is a common age-related degenerative condition that affects the vertebrae, intervertebral discs, and associated ligaments of the cervical spine [17]. By age 60, 95% of men and 70% of women show radiographic evidence of cervical spondylosis [9], and approximately 8% have MRI evidence of early spinal cord compression [13]. Patients may present with varying combinations of radiculopathy, progressive myelopathy, and axial neck pain [6]. For those who fail to improve with conservative management, decompression through anterior cervical discectomy and fusion is an established and effective sur- gical option [8]. Following fusion, however, compensatory changes at adjacent spinal levels may lead to accelerated degeneration and recurrence of symptoms. Estimates of the clinical importance and prevalence of adjacent segment disease are highly variable [8]. Cervical intervertebral disc arthroplasty is an alternative procedure intended to prevent adjacent segment disease by maintaining spinal motion. Biomechanical, clinical, and radiographic data suggest its effectiveness, but long-term data are lacking, and the benefits of motion-preservation remain theoretical [1, 4, 7, 10, 18, 19]. This systematic review and meta-analysis sought to determine whether arthroplasty is as least as successful as fusion at relieving pain and preventing neurological decline at short-term followup. (Boselie TFM, Willems PC, van Mameren H, de Bie R, Benzel EC, van Santbrink H. Arthroplasty versus fusion in single-level cervical degenerative disc disease. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD009173. DOI: 10.1002/14651858. CD009173.pub2. Copyright The Cochrane Collaboration, Published by John Wiley & Sons, Ltd., reproduced with permission.) A Note from the Editor-in-Chief: I am pleased to announce the partnership between CORR 1 , The Cochrane Collaboration 1 , and McMaster University’s Evidence-Based Orthopaedics Group for a new column, called Cochrane in CORR 1 . In it, we will identify an abstract originally published in The Cochrane Library that we think is especially important, and Dr. Mohit Bhandari, our Deputy Editor for Evidence-Based Orthopaedics, and his colleagues from McMaster University will provide expert perspective on it. The author certifies that he, or a member of his immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR 1 or the Association of Bone and Joint Surgeons 1 . Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and The Cochrane Library (http://www. thecochranelibrary.com) should be consulted for the most recent version of the review. This Cochrane in CORR 1 column refers to the abstract available at: DOI: 10.1002/14651858.CD009173.pub2. N. Evaniew, M. Bhandari Division of Orthopaedics, McMaster University, Hamilton, ON, Canada N. Evaniew (&) Division of Orthopaedics, Center for Evidence-Based Orthopaedics, 293 Wellington Street North, Suite 110, Hamilton, ON L8L 8E7, Canada e-mail: [email protected]K. Madden, M. Bhandari Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada 123 Clin Orthop Relat Res (2014) 472:802–808 DOI 10.1007/s11999-013-3284-0 Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons®
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COCHRANE IN CORR
Cochrane in CORR1: Arthroplasty Versus Fusion in Single-levelCervical Degenerative Disc Disease
Nathan Evaniew MD, Kim Madden Bsc,
Mohit Bhandari MD, PhD, FRCSC
Received: 14 August 2013 / Accepted: 4 September 2013 / Published online: 28 September 2013
� The Association of Bone and Joint Surgeons1 2013
Importance of the Topic
Cervical spondylosis is a common age-related degenerative
condition that affects the vertebrae, intervertebral discs,
and associated ligaments of the cervical spine [17]. By age
60, 95% of men and 70% of women show radiographic
evidence of cervical spondylosis [9], and approximately
8% have MRI evidence of early spinal cord compression
[13]. Patients may present with varying combinations of
radiculopathy, progressive myelopathy, and axial neck pain
[6]. For those who fail to improve with conservative
management, decompression through anterior cervical
discectomy and fusion is an established and effective sur-
gical option [8]. Following fusion, however, compensatory
changes at adjacent spinal levels may lead to accelerated
degeneration and recurrence of symptoms. Estimates of the
clinical importance and prevalence of adjacent segment
disease are highly variable [8].
Cervical intervertebral disc arthroplasty is an alternative
procedure intended to prevent adjacent segment disease by
maintaining spinal motion. Biomechanical, clinical, and
radiographic data suggest its effectiveness, but long-term
data are lacking, and the benefits of motion-preservation
remain theoretical [1, 4, 7, 10, 18, 19]. This systematic
review and meta-analysis sought to determine whether
arthroplasty is as least as successful as fusion at relieving
pain and preventing neurological decline at short-term
followup.
(Boselie TFM, Willems PC, van Mameren H, de Bie R, Benzel EC,
van Santbrink H. Arthroplasty versus fusion in single-level cervical
degenerative disc disease. Cochrane Database of Systematic Reviews