Neurosurg Focus. 2026 Jul 1;61(1):E4. doi: 10.3171/2026.3.FOCUS2617.
ABSTRACT
OBJECTIVE: The aim of this study was to determine the risks of reoperations for adjacent segment disease (ASD) and all causes between 1-level cervical disc arthroplasty (CDA) and 1-level anterior cervical discectomy and fusion (ACDF) and 2-level CDA and 2-level ACDF using meta-analysis. This study was specifically designed to address several key methodological limitations of prior meta-analyses, including cohort duplication, short follow-up duration, non-level-matched pooling of 1-level and 2-level procedures, and exclusion of international randomized controlled trials (RCTs).
METHODS: Using PRISMA guidelines, the authors performed a thorough search of the PubMed, Embase, and Scopus databases from January 2012 through November 2025. Studies were restricted to FDA investigational device exemption (IDE) trials and international RCTs with > 5 years of follow-up. Direct pairwise meta-analyses were conducted, and odds ratios and standard errors were calculated for outcomes. Random-effects pooling was performed, and between-study heterogeneity was assessed using Cochran’s Q statistic and the I2 statistic.
RESULTS: A total of 1756 studies were identified from the databases with 199 studies available for full review. Sixteen studies were selected for the analysis. For ASD reoperations in 13 studies, the authors found that 1-level CDA was associated with an approximately 55% lower odds of reoperation for ASD compared with 1-level ACDF (OR 0.45, 95% CI 0.29-0.69; p < 0.001). For 2-level CDA, there was a 49% lower chance of having an ASD reoperation compared with 2-level ACDF (OR 0.51, 95% CI 0.30-0.87; p = 0.013). Similarly, in 14 studies, there was a statistically significant reduction in the odds of all-cause reoperations in 1-level CDA compared with ACDF (OR 0.58, 95% CI 0.42-0.80; p = 0.001) while for 2-level CDAs there was a 52% lower chance of all-cause reoperations compared with 2-level ACDFs (OR 0.48, 95% CI 0.32-0.72; p < 0.001).
CONCLUSIONS: In this comprehensive, level-matched meta-analysis of FDA IDE studies and international RCTs in which we addressed several key methodological limitations of prior meta-analyses, we found that 1-level and 2-level CDAs were associated with a consistent reduction in reoperation risks compared with ACDF for ASD and all-cause reoperations with a mean 7-year follow-up. Future investigations leveraging large, prospective registries will be essential to determine the generalizability of IDE studies and international RCTs to the broader clinical populations.
PMID:42385252 | DOI:10.3171/2026.3.FOCUS2617
