Cervical Disk Arthroplasty Versus Anterior Cervical Decompression and Fusion for the Treatment of 2-Level Cervical Spondylopathy: A Systematic Review and Meta-analysis

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Study Design:

Systematic review and meta-analysis.


To assess the safety and efficacy of cervical disk arthroplasty (CDA) compared with anterior cervical decompression and fusion (ACDF) for the treatment of 2-level cervical spondylopathy.

Summary of Background Data:

CDA has emerged as a potential alternative to ACDF in patients with cervical disk degeneration. But there are no published systematic reviews and meta-analyses comparing CDA with ACDF for the treatment of 2-level cervical spondylopathy.


The Pubmed, Embase, Web of science, Scopus, and Cochrane library databases were searched comparing CDA to ACDF in patients with 2-level cervical spondylopathy. Outcome measures were neck disability index, visual analog scale (VAS) of arm and neck pain, range of movement (ROM) at C2–C7, functional segment unit ROM, ROM at the operated level, and incidence of radiologic changes at adjacent levels approximately 2 years after surgery, as well as operating time and incidence of surgery-related complications. Mean difference (MD), odds ratios (OR), and their corresponding 95% confidence intervals (95% CIs) were calculated.


Six studies involving 646 patients were included. There were no significant differences in neck disability index (MD, −1.53; 95% CI −3.80 to 0.73), VAS neck pain (MD, −0.19; 95% CI −0.71 to 0.33), and VAS arm pain (MD, −0.23; 95% CI −0.61 to 0.16) between 2-level CDA and 2-level ACDF cases. ROM at C2–C7 (MD, 15.82; 95% CI, 10.66–20.99), functional segment unit ROM (MD, 8.58; 95% CI, 7.93–9.23), and ROM at the operated level (MD, 9.54; 95% CI, 7.73–11.35) were greater, but the incidence of radiologic changes at adjacent levels (OR, 0.29; 95% CI, 0.13–0.67) were lower, in 2-level CDA cases. In 2-level CDA cases, the operating time was longer (MD, 57.41; 95% CI, 24.67–90.14), but surgery-related complications rates (OR, 0.47; 95% CI, 0.30–0.74) was lower.


CDA may be a safe and effective alternative to ACDF for the treatment of 2-level cervical degenerative disease.

Level of Evidence:

Level II.

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