Comparison of total disc replacement versus fusion for lumbar degenerative disc disease: a Meta-analysis of randomized controlled trials / 中华外科杂志

ABSTRACT

<p><b>OBJECTIVE</b>To 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.</p><p><b>METHODS</b>Computer 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.</p><p><b>RESULTS</b>Total 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%CI0.21-0.95, 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.</p><p><b>CONCLUSION</b>Regardless 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.</p>