Reoperation After Cervical Disc Arthroplasty Versus Anterior Cervical Discectomy and Fusion: A Meta-analysis.

BACKGROUND: Anterior cervical discectomy and fusion is a standard surgical treatment for cervical radiculopathy and myelopathy, but reoperations sometimes are performed to treat complications of fusion such as pseudarthrosis and adjacent-segment degeneration. A cervical disc arthroplasty is designed to preserve motion and avoid the shortcomings of fusion. Available evidence suggests that a cervical disc arthroplasty can provide pain relief and functional improvements similar or superior to an anterior cervical discectomy and fusion. However, there is controversy regarding whether a cervical disc arthroplasty can reduce the frequency of reoperations. QUESTIONS/PURPOSES: We performed a meta-analysis of randomized controlled trials (RCTs) to compare cervical disc arthroplasty with anterior cervical discectomy and fusion regarding (1) the overall frequency of reoperation at the index and adjacent levels; (2) the frequency of reoperation at the index level; and (3) the frequency of reoperation at the adjacent levels. METHODS: PubMed, EMBASE, and the Cochrane Register of Controlled Trials databases were searched to identify RCTs comparing cervical disc arthroplasty with anterior cervical discectomy and fusion and reporting the frequency of reoperation. We also manually searched the reference lists of articles and reviews for possible relevant studies. Twelve RCTs with a total of 3234 randomized patients were included. Eight types of disc prostheses were used in the included studies. In the anterior cervical discectomy and fusion group, autograft was used in one study and allograft in 11 studies. Nine of 12 studies were industry sponsored. Pooled risk ratio (RR) and associated 95% CI were calculated for the frequency of reoperation using random-effects or fixed-effects models depending on the heterogeneity of the included studies. A funnel plot suggested the possible presence of publication bias in the available pool of studies; that is, the shape of the plot suggests that smaller negative or no-difference studies may have been performed but have not been published, and so were not identified and included in this meta-analysis. RESULTS: The overall frequency of reoperation at the index and adjacent levels was lower in the cervical disc arthroplasty group (6%; 108/1762) than in the anterior cervical discectomy and fusion group (12%; 171/1472) (RR, 0.54; 95% CI, 0.36-0.80; p = 0.002). Subgroup analyses were performed according to secondary surgical level. Compared with anterior cervical discectomy and fusion, cervical disc arthroplasty was associated with fewer reoperations at the index level (RR, 0.50; 95% CI, 0.37-0.68; p < 0.001) and adjacent levels (RR, 0.52; 95% CI, 0.37-0.74; p < 0.001). CONCLUSIONS: Cervical disc arthroplasty is associated with fewer reoperations than anterior cervical discectomy and fusion, indicating that it is a safe and effective alternative to fusion for cervical radiculopathy and myelopathy. However, because of some limitations, these findings should be interpreted with caution. Additional studies are needed. LEVEL OF EVIDENCE: Level I, therapeutic study.

Late-Onset Nail Changes Associated with Hand, Foot, and Mouth Disease: A Clinical Analysis of 56 Cases.

OBJECTIVES: To investigate the development and clinical characteristics of nail changes in hand, foot, and mouth disease (HFMD). METHODS: A telephone survey was conducted with the parents of patients diagnosed with HFMD in the Fourth General Hospital of Nanhai from June to August 2013 to document nail changes within 3 months of diagnosis of HFMD. RESULTS: Valid survey results were obtained from 273 cases. Definitive nail changes were identified in 56 patients (20.5%). More boys (25.8%) than girls (10.6%) (p < 0.01) showed changes. The age distribution ranged from 1 to 5 years, and nail changes were rare in children younger than 1 year of age (p < 0.01). Nail changes were usually seen 1 to 2 months after the onset of HFMD and lasted for 1 to 8 weeks, most for approximately 4 weeks. Toenails or fingernails could be affected and the changes were more likely to occur synchronously. Fingernails were more commonly involved than toenails. When both fingernails and toenails were involved, this typically occurred synchronously. Although there were cases with all toenails and fingernails involved (16.1%), we did not encounter any instances involving 13 to 19 nails. The nail changes mainly presented as onychomadesis. Spontaneous recovery without special treatment was the course for all patients. No relapse or new nail involvement was identified. CONCLUSIONS: Nail change associated with HFMD usually occurs within 1 to 2 months after onset, mainly presents as onychomadesis, and is a self-limited process. Possible mechanisms are discussed.

Does cervical disc arthroplasty have lower incidence of dysphagia than anterior cervical discectomy and fusion? A meta-analysis.

OBJECTIVE: Dysphagia is a common occurrence after anterior cervical spine surgery. The aim of this meta-analysis was to evaluate the incidence of dysphagia after ervical disc arthroplasty (CDA) compared with anterior cervical discectomy and fusion (ACDF). MATERIAL AND METHODS: The electronic databases, including PubMed, EMBASE and Cochrane Central Register of Controlled Trials, were searched to identify the randomized controlled trials comparing CDA with ACDF. Studies were included only if the incidence of postoperative dysphagia was investigated. Study selection, "risk of bias" assessment, and data extraction were independently performed by two investigators. Data analyses were conducted with RevMan 5.3 software. RESULTS: Ten studies involving 2711 patients (CDA group, n=1512; ACDF group, n=1199) were identified. All studies were determined to have a low risk of bias. Pooling analysis of these studies showed that the incidence of dysphagia was 9.46% (143/1512) after CDA versus 12.09% (145/1199) after ACDF. Meta-analysis showed the statistical difference between two groups with regards to the incidence of dysphagia (risk ratio 0.76; 95% confidence interval [0.61, 0.94]; P=0.01). CONCLUSION: This meta-analysis indicates that patients have a significantly lower incidence of dysphagia after CDA than after ACDF. Additional studies are needed.