1.
Radiographic and clinical outcomes of silicate-substituted calcium phosphate (SiCaP) bone grafts in spinal fusion: Systematic review and meta-analysis.
Cottrill, E, Premananthan, C, Pennington, Z, Ehresman, J, Theodore, N, Sciubba, DM, Witham, T
Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. 2020;:353-366
Abstract
Pseudarthrosis continues to affect a nontrivial proportion of spine fusion patients. Given its ties to poorer patient outcomes and high reoperation rates, there remains great interest in interventions aimed at reducing the rates of nonunion. Recently, silicate-substituted calcium phosphate (SiCaP) bone grafts have been suggested to improve fusion rates, yet there exists no systematic review of the body of evidence for SiCaP grafts. Here, we present the first such review along with a meta-analysis of the effect of SiCaP bone grafts on fusion rates. Using the PubMed, Embase, and Web of Science databases, we queried the English-language literature for all studies examining the effect of SiCaPs on spinal fusion. Primary endpoints were: 1) radiographic fusion rate at last follow-up and 2) postoperative improvements in Visual Analog Scale (VAS) pain scores and Oswestry Disability Index (ODI) at last follow-up. Meta-analyses were performed for each endpoint using random effects. Ten articles (694 patients treated with SiCaP bone grafts) were included. Among SiCaP-treated patients, 93% achieved radiographic fusion (range: 79-100%), with comparable rates across subgroups. Meta-analysis of the three randomized controlled trials demonstrated no difference in fusion rates between SiCaP-treated patients and patients receiving grafts with recombinant human bone morphogenetic protein-2 (rhBMP-2) (OR: 1.11; p = 0.83). Patients treated with SiCaP bone grafts experienced significant improvements in VAS back pain (-3.3 points), VAS leg pain (-4.8 points), and ODI (-31.6 points) by last follow-up (p < 0.001 for each). Additional high-quality research is needed to evaluate the relative cost-effectiveness of SiCaP bone grafts in spinal fusion.
2.
Structural Allograft versus Polyetheretherketone Implants in Patients Undergoing Spinal Fusion Surgery: A Systematic Review and Meta-Analysis.
Fatima, N, Massaad, E, Shankar, GM, Shin, JH
World neurosurgery. 2020;:101-109
Abstract
OBJECTIVE Interbody spacers have been successfully used in spinal fusion procedures with the aim to restore disc height, provide stability, and promote bone fusion. The authors evaluated the efficacy of structural body allograft versus polyetheretherketone (PEEK) implants in patients undergoing spinal fusion surgery. METHODS A systematic review of electronic databases was conducted using different Medical Subject Headings terms from January 1970 to August 2019. Pooled and subgroup analyses were performed using random-effects and fixed-effects models based on I2 heterogeneity. RESULTS The analysis included 6640 patients (structural allograft 64% and PEEK cage 36%) from 7 comparative studies. There were no statistically significant differences in age (P = 0.27), sex (P = 0.31), body mass index (P = 0.82), and smoking status (P = 0.27) between the 2 groups. Overall, the mean follow-up was 12.9 ± 1.5 months. Pooled meta-analysis revealed that patients with structural allograft had 2.59-fold higher likelihood of fusion compared with patients with PEEK cages (odds ratio [OR] 2.59, 95% confidence interval [CI] 1.02-6.57, P = 0.05) at last follow-up evaluation. Patients with structural allograft had 61% less likelihood of pseudarthrosis (OR 0.39, 95% CI 0.15-0.98, P = 0.05) and 74% lower incidence of reoperation compared with patients with PEEK implants (OR 0.26, 95% CI 0.09-0.79, P = 0.02). Our results suggest that patients with structural allografts had a higher subsidence rate compared with patients with PEEK implants, but this was statistically insignificant (OR 1.07, 95% CI 0.45-2.53, P = 0.89). CONCLUSIONS Our results corroborate that structural allografts are highly effective in promoting bony fusion compared with PEEK implants in patients undergoing spinal fusion surgery.
3.
Effects of teriparatide and bisphosphonate on spinal fusion procedure: A systematic review and network meta-analysis.
Cheng, SH, Kuo, YJ, Chen, C, Kang, YN
PloS one. 2020;(9):e0237566
Abstract
BACKGROUND Giving patients anti-osteoporotic agents peri-operatively is a well-accepted strategy to increase fusion rate and prevent complications. The purpose of this study was to investigate effectiveness of teriparatide and bisphosphonate on fusion surgery of thoracic and lumbar spine. METHODS We searched EMBASE and PubMed for randomized clinical trials (RCTs) and prospective comparative studies using teriparatide or bisphosphonate in peri-operative spinal fusion surgery. Our synthesized data of fusion rate, Oswestry disability index (ODI), and adverse event in contrast-based network meta-analysis. Pooled results were presented in risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI). RESULTS Our search hit eight RCTs and three prospective studies with 676 patients receiving spinal surgery. Pooled result showed that teriparatide+Denosumab leads to significantly higher fusion rate than placebo (RR, 2.84; 95% CI: 1.22 to 6.60) and bisphosphonate (RR, 2.59; 95% CI: 1.13 to 5.96). We did not observe significant finding among placebo, teriparatide, and bisphosphonate in the two network models. CONCLUSION This is the first network meta-analysis providing an overview of the use of teriparatide and bisphosphonate for spinal fusion surgery. Teriparatide treatments are worth to be consider for spinal fusion surgery.
4.
Is PEEK cage better than titanium cage in anterior cervical discectomy and fusion surgery? A meta-analysis.
Li, ZJ, Wang, Y, Xu, GJ, Tian, P
BMC musculoskeletal disorders. 2016;(1):379
Abstract
BACKGROUND This meta-analysis was performed to identify the benefits and disadvantages of the PEEK cage and titanium cage. METHODS We used "cervical or cervicle", "titanium", and "polyetheretherketone or PEEK" as keywords. Medline, Embase, Cochrane Central Register of Controlled Trials and other databases were searched to identify eligible studies that were published before October 2015. In addition, the Google search engine was used to manually search for relevant journals or conference proceedings. Randomized controlled trials and non-randomized controlled trials that compared the PEEK cage and titanium cage for anterior cervical surgery were included. The meta-analysis was performed with RevMan 5.1 software. RESULTS Two randomized and two non-randomized clinical trials were retrieved with a total of 184 segments from 107 patients in the PEEK cage group and 211 segments from 128 patients in the titanium cage group. The quality assessment scores ranged from 16 to 18 with high heterogeneity. There were no differences in functional status according to the Odom criteria, fusion rate, final local segmental angle and loss of correction between the two groups. Although more subsidence occurred in the titanium cage group, the effects of loss of the local segmental angle or the whole cervical Cobb angle on cervical function in the long-term are still not clear. CONCLUSION The present meta-analysis indicated no significant difference in functional and radiographic performance between the PEEK and titanium cages, although more subsidence occurred in the titanium cage group. More high-quality studies are needed to confirm these results to offer more information for the choice in clinical practice.