Clinica Ortopedica, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy.
Department of Mathematics, University of Genoa, Via Dodecaneso 35, 16146, Genoa, GE, Italy.
Musculoskelet Surg. 2020 Apr;104(1):1-15. doi: 10.1007/s12306-019-00634-x. Epub 2020 Jan 1.
The aim of this meta-analysis and systematic review is to summarize and critically analyze the influence of surgery-related factors in lumbar interbody fusion for degenerative spine diseases. A systematic review of the literature was carried out with a primary search being performed on Medline through PubMed. The 2009 PRISMA flowchart and checklist were taken into account. Sixty-seven articles were included in the analysis: 48 studies were level IV of evidence, whereas 19 were level III. All interbody fusion techniques analyzed have proved to reach a good fusion rate. An overall mean fusion rate of 93% (95% CI 92-95%, p < 0.001) was estimated pooling the selected studies. The influence of sagittal parameters and cages features in fusion rate was not clear. Autograft is considered the gold standard material. The use of synthetic bone substitutes and biological factors alone or combined with bone graft have shown conflicting results. Low level of evidence studies and high heterogeneity (χ = 271.4, df = 72, p < 0.001; I = 73.5%, τ = 0.05) in data analysis could result in the risk of bias. Further high-quality studies would better clarify these results in the future.
本荟萃分析和系统评价的目的是总结和批判性分析与退行性脊柱疾病的腰椎体间融合相关的手术因素的影响。通过 PubMed 对 Medline 进行了初步检索，进行了文献的系统回顾。考虑到 2009 年 PRISMA 流程图和清单。共有 67 篇文章纳入分析：48 项研究为证据 4 级，19 项为证据 3 级。分析的所有椎间融合技术都已证明融合率较高。通过对选定的研究进行汇总，总体融合率估计为 93%（95%CI 92-95%，p<0.001）。矢状参数和笼状特征对融合率的影响尚不清楚。自体移植物被认为是金标准材料。单独使用或与骨移植物联合使用合成骨替代物和生物因子的结果存在冲突。低水平证据研究和高异质性（χ²=271.4，df=72，p<0.001；I=73.5%，τ=0.05）可能导致数据分析中的偏倚风险。未来还需要高质量的研究来更好地阐明这些结果。
