Patel Manan Sunil, McCormick Johnathon R, Ghasem Alexander, Huntley Samuel R, Gjolaj Joseph P
The University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA.
Department of Orthopedic Surgery, University of Miami Hospital, Miami, FL, USA.
J Spine Surg. 2020 Mar;6(1):72-86. doi: 10.21037/jss.2020.01.01.
Tantalum is a porous metal, whose elastic modulus, high frictional properties and biocompatibility make it an ideal construct to facilitate adequate bony fusion in spine surgery. Since 2015, the published literature on clinical outcomes of tantalum in spine surgery has more than doubled. A review of the literature was performed on the PubMed (MEDLINE) database on January 27, 2019, for papers pertinent to the use of tantalum metal in spine surgery. Thirteen studies were included in this review. For cervical spine, we found increased fusion rates in autograft alone compared to tantalum standalone (92.8% . 89.0%, P=0.001) and tantalum cages plus autograft (92.8% . 64.8%, P<0.0001). Complication rates in cervical fusion were lower in patients treated with tantalum standalone versus those treated with autograft (7.4% . 13.7%, P<0.0001), and autograft and anterior plate (7.4% . 33%, P=0.001). Autograft patients had higher rates of revision surgery compared to tantalum standalone (12.8% . 2.8%, P<0.0001) and tantalum ring with autograft (12.8% . 7.7%, P<0.001). For lumbar spine, we found autograft had lower fusion rate compared to tantalum standalone (80.0% . 93.4%, P<0.0001). Use of tantalum metal in spine fusion surgery shows promising results in fusion, complication and revision rates, and clinical outcomes compared to autograft. Although, fusion rates in short-term studies evaluating tantalum in the cervical spine are conflicting, long-term series beyond 2 years show excellent results. This early finding may be related difficulties in radiographic evaluation of fusion in the setting of tantalum cage use. Further studies are needed to further delineate the timing of fusion with the implementation of tantalum in the cervical and lumbar spine.
钽是一种多孔金属，其弹性模量、高摩擦性能和生物相容性使其成为脊柱手术中促进充分骨融合的理想结构。自2015年以来，关于钽在脊柱手术中临床结果的已发表文献增加了一倍多。2019年1月27日在PubMed（MEDLINE）数据库上对与钽金属在脊柱手术中的使用相关的论文进行了文献综述。本综述纳入了13项研究。对于颈椎，我们发现单纯自体骨移植的融合率高于单独使用钽（92.8%对89.0%，P = 0.001）以及钽笼加自体骨移植（92.8%对64.8%，P < 0.0001）。单独使用钽治疗的颈椎融合患者的并发症发生率低于自体骨移植患者（7.4%对13.7%，P < 0.0001）以及自体骨移植和前路钢板治疗的患者（7.4%对33%，P = 0.001）。与单独使用钽（12.8%对2.8%，P < 0.0001）以及钽环加自体骨移植（12.8%对7.7%，P < 0.001）相比，自体骨移植患者的翻修手术率更高。对于腰椎，我们发现自体骨移植的融合率低于单独使用钽（80.0%对93.4%，P < 0.0001）。与自体骨移植相比，在脊柱融合手术中使用钽金属在融合、并发症和翻修率以及临床结果方面显示出有前景的结果。尽管在评估钽在颈椎中的短期研究中融合率存在矛盾，但超过2年的长期系列研究显示出优异的结果。这一早期发现可能与在使用钽笼的情况下融合的影像学评估困难有关。需要进一步的研究来进一步明确在颈椎和腰椎中使用钽时融合的时机。
