Department of Orthopedics, Changhai Hospital, Second Military Medical University, Shanghai, China.
Spine (Phila Pa 1976). 2011 Apr 1;36(7):E461-8. doi: 10.1097/BRS.0b013e3181dfd163.
Meta-analysis of literature.
To evaluate the effect of perioperative nonsteroidal anti-inflammatory drugs (NSAIDs) on the success rate of adult spinal fusion.
NSAIDs are commonly used to treat postsurgical orthopedic pain. Studies on animal models have shown a significant inhibiting effect of NSAIDs on osteogenesis process, on which spinal fusion also depends. Recently, great interest has been shown in the effect of NSAIDs on the success rate of adult spinal fusion. Clinical trials have tested the effect of perioperative NSAIDs in spinal fusion procedures. A cumulative result of these studies would give more credit to the final conclusions.
A systematic search of electronic databases and references from eligible articles was conducted. Comparative studies reporting on the results of primary spinal fusion including treatment group of NSAIDs perioperatively were regarded eligible. A pooled estimate of effect size was produced using both random and fixed effect model.
Five retrospective comparative studies (n = 1403 participants) were included in the present study. The mean age of these patients was more than 40 years and none of them had NSAIDs for longer than 14 days following spinal fusion surgery. High-dose ketorolac showed a statistically significant adverse effect on spinal fusion (P = 0.001, RR = 2.87, 95% CI = 1.53 = - 5.38) with no statistical heterogeneity (I = 3%, P = 0.38), whereas normal-dose NSAIDs (ketorolac, diclofenac sodium, celecoxib, or rofecoxib) did not appear to produce inferior results than the no-NSAIDs group (P = 0.30, RR = 1.39, 95% CI = 0.74 - 2.61) with no statistical heterogeneity (I² = 0%, P = 0.50).
Although randomized controlled trials would be optimal for meta-analyses, the data of this review revealed that short-time (<14 days) exposure to normal-dose NSAIDs (ketorolac, diclofenac sodium, celecoxib, or rofecoxib) were safe after spinal fusion, whereas short-time (<14 days) exposure to high-dose ketorolac increased the risk of nonunion, which meant that the effect of perioperative NSAIDs on spinal fusion might be dose-dependent. Further studies would be needed to find out whether long-time exposure to normal-dose NSAIDs could also increase the risk of nonunion and which type of NSAIDs would like to have a worse effect on spinal fusion.
文献荟萃分析。
评估围手术期非甾体抗炎药（NSAIDs）对成人脊柱融合成功率的影响。
NSAIDs 常用于治疗术后骨科疼痛。动物模型研究表明，NSAIDs 对成骨过程有显著的抑制作用，而脊柱融合也依赖于成骨过程。最近，人们对 NSAIDs 对成人脊柱融合成功率的影响产生了浓厚的兴趣。临床试验已经测试了围手术期 NSAIDs 在脊柱融合手术中的效果。对这些研究的累积结果将为最终结论提供更多依据。
对电子数据库和合格文章的参考文献进行系统搜索。将报告包括围手术期 NSAIDs 治疗组在内的主要脊柱融合结果的对照研究视为合格研究。使用随机和固定效应模型生成效应大小的汇总估计值。
本研究纳入了 5 项回顾性对照研究（n = 1403 名参与者）。这些患者的平均年龄超过 40 岁，且没有患者在脊柱融合手术后使用 NSAIDs 超过 14 天。高剂量酮咯酸对脊柱融合有显著的不良影响（P = 0.001，RR = 2.87，95%CI = 1.53 - 5.38），且无统计学异质性（I = 3%，P = 0.38），而正常剂量的 NSAIDs（酮咯酸、双氯芬酸钠、塞来昔布或罗非昔布）似乎并未产生比无 NSAIDs 组更差的结果（P = 0.30，RR = 1.39，95%CI = 0.74 - 2.61），且无统计学异质性（I² = 0%，P = 0.50）。
尽管随机对照试验对荟萃分析最理想，但本研究的数据表明，短期（<14 天）使用正常剂量的 NSAIDs（酮咯酸、双氯芬酸钠、塞来昔布或罗非昔布）在脊柱融合后是安全的，而短期（<14 天）使用高剂量酮咯酸会增加不愈合的风险，这意味着围手术期 NSAIDs 对脊柱融合的影响可能是剂量依赖性的。需要进一步的研究来确定长期使用正常剂量的 NSAIDs 是否也会增加不愈合的风险，以及哪种 NSAIDs 对脊柱融合的影响更差。
