Anterior Cervical Discectomy and Fusion Versus Cervical Disc Arthroplasty for Cervical Degenerative Disc Disease: Alarming Rates of Bias.
- 1Department of Orthopedic Surgery, University of Southern California (USC) Keck School of Medicine, Los Angeles, CA, USA.
- 2Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, USA.
Abstract
Study DesignCross-Sectional.ObjectivesWhether cervical disc arthroplasty (CDA) or anterior cervical discectomy and fusion (ACDF) yields better outcomes in cervical degenerative disc disease remains unsettled, and clinicians turn to evidence syntheses for guidance. These syntheses, however, may contain spin, a reporting bias that presents an intervention as more effective or safer than the data support. This study sought to characterize how often spin appears in reviews comparing ACDF and CDA, which forms it takes, and whether methodological quality, journal impact factor, or citation rate predicts spin outcomes.MethodsPubMed, Web of Science, and Embase were searched for systematic reviews and meta-analyses directly comparing ACDF and CDA. Each article was assessed for spin using the Yavchitz classification system and for methodological quality (AMSTAR-2). Logistic and Poisson regression assessed whether study AMSTAR-2 rating, journal impact factor, and yearly citations predicted spin outcomes.Results77 articles were included. Spin was identified in 49 (63.6%); all spin-positive reviews favored CDA. The most frequent types were claiming benefit despite high risk of bias (39.0%), overemphasis on efficacy (26.0%), and selective safety reporting (15.6%). AMSTAR-2 ratings were poor: 83.1% were critically low, 15.6% low, and 1.3% high. Lower AMSTAR-2 rating independently predicted spin (OR 0.182, 95% CI 0.048-0.689, p = 0.012); impact factor and citations did not.ConclusionsSpin is prevalent in reviews comparing CDA with ACDF and uniformly favors CDA. Greater methodological rigor and balanced reporting are needed for evidence syntheses to reliably inform clinical decisions.
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BibTeX
@article{davood2026anterior,
title = {{Anterior Cervical Discectomy and Fusion Versus Cervical Disc Arthroplasty for Cervical Degenerative Disc Disease: Alarming Rates of Bias.}},
author = {Joshua Davood and Henry Avetisian and Daniel Rusu and Marco Napolitano and Joshua Khorsandi and Apurva Prasad and Joseph Borna and Joseph Noorvash and Nicole Kahen and Aidan Lindgren and William J Karakash and Thomas W Mason and Jeffrey C Wang and Raymond J Hah and Ram K Alluri},
journal = {Global spine journal},
year = {2026},
month = nov,
doi = {10.1177/21925682261504746},
url = {https://europepmc.org/article/MED/42970754},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Anterior Cervical Discectomy and Fusion Versus Cervical Disc Arthroplasty for Cervical Degenerative Disc Disease: Alarming Rates of Bias.
AU - Joshua Davood
AU - Henry Avetisian
AU - Daniel Rusu
AU - Marco Napolitano
AU - Joshua Khorsandi
AU - Apurva Prasad
AU - Joseph Borna
AU - Joseph Noorvash
AU - Nicole Kahen
AU - Aidan Lindgren
AU - William J Karakash
AU - Thomas W Mason
AU - Jeffrey C Wang
AU - Raymond J Hah
AU - Ram K Alluri
PY - 2026
DA - 2026/11/02
JO - Global spine journal
DO - 10.1177/21925682261504746
UR - https://europepmc.org/article/MED/42970754
AB - Study DesignCross-Sectional.ObjectivesWhether cervical disc arthroplasty (CDA) or anterior cervical discectomy and fusion (ACDF) yields better outcomes in cervical degenerative disc disease remains unsettled, and clinicians turn to evidence syntheses for guidance. These syntheses, however, may contain spin, a reporting bias that presents an intervention as more effective or safer than the data support. This study sought to characterize how often spin appears in reviews comparing ACDF and CDA, which forms it takes, and whether methodological quality, journal impact factor, or citation rate predicts spin outcomes.MethodsPubMed, Web of Science, and Embase were searched for systematic reviews and meta-analyses directly comparing ACDF and CDA. Each article was assessed for spin using the Yavchitz classification system and for methodological quality (AMSTAR-2). Logistic and Poisson regression assessed whether study AMSTAR-2 rating, journal impact factor, and yearly citations predicted spin outcomes.Results77 articles were included. Spin was identified in 49 (63.6%); all spin-positive reviews favored CDA. The most frequent types were claiming benefit despite high risk of bias (39.0%), overemphasis on efficacy (26.0%), and selective safety reporting (15.6%). AMSTAR-2 ratings were poor: 83.1% were critically low, 15.6% low, and 1.3% high. Lower AMSTAR-2 rating independently predicted spin (OR 0.182, 95% CI 0.048-0.689, p = 0.012); impact factor and citations did not.ConclusionsSpin is prevalent in reviews comparing CDA with ACDF and uniformly favors CDA. Greater methodological rigor and balanced reporting are needed for evidence syntheses to reliably inform clinical decisions.
SN - 2192-5682
SN - 2192-5690
ER -