Comparison of total disc replacement with lumbar fusion: a meta-analysis of randomized controlled trials

ABSTRACT

A meta-analysis was performed to evaluate whether a beneficial clinical effect of the Total Disc Replacement [TDR] over lumbar fusion for the treatment of patients with Degenerative Disc Disease [DDD]. An electronic search of PubMed, Cochrane Central Register of Controlled Trials, and EMBASE from their inception to 2012 was completed, and we assessed risk bias and retrieved relevant data, and meta-analysis was performed, if appropriate. Oswestry Disability Index [ODI], Visual Analog Score [VAS], patient satisfaction or VAS patient satisfaction, narcotic use, overall success rate, reoperation rate, work status, "surgery again?", complications and radiographic outcomes were evaluated. Six RCTs were included in this meta-analysis. At 2 years, TDR was demonstrated to be more beneficial for patients compared to lumbar fusion in the following outcomes, including ODI scores [MD-4.87, 95% CI -7.77 to -1.97, p=0.001], patient satisfaction [OR1.91, 95% CI 1.27 to 2.86, p=0.002] and VAS patient satisfaction [MD9.10, 95% CI 3.20 to 14.99, p=0.002], the percentage of using narcotics [OR=0.54, 95%CI 0.31 to 0.96, p=0.03], overall success rate [OR1.68, 95% CI 1.26 to 2.25, p=0.005], the rate of patients to chose the same surgical treatment again [OR2.38, 95% CI 1.72 to 3.28, p < 0.001], and complications [OR=0.50, 95%CI 0.29 to 0.84, p=0.008]. Other outcomes, including re-operation rate [OR0.62, 95% CI 0.36 to 1.06, p=0.08] and work status [OR=1.05, 95% CI 0.75 to 1.47, p=0.80], were demonstrated to be no differences between the two groups. In a long-term of follow-up [2 years], TDR shows a significant superiority for the treatment of lumbar DDD compared with fusion