Department of Research of IPSPAC-Instituto Paulista de Saúde para Alta Complexidade, 215 Alameda Terracota, cj 407, Sao Caetano do Sul, SP, 09531-190, Brazil.
Institute of Neurology, University of São Paulo, 255 Dr. Enéas de Carvalho Aguiar avenue, Cerqueira César, São Paulo, SP, 05403-900, Brazil.
Sci Rep. 2022 May 9;12(1):7546. doi: 10.1038/s41598-022-11551-8.
Our study aimed to evaluate differences in outcomes of patients submitted to spinal fusion using different grafts measuring the effectiveness of spinal fusion rates, pseudarthrosis rates, and adverse events. Applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, this systematic review and meta-analysis identified 64 eligible articles. The main inclusion criteria were adult patients that were submitted to spinal fusion, autologous iliac crest (AIC), allograft (ALG), alloplastic (ALP; hydroxyapatite, rhBMP-2, rhBMP-7, or the association between them), and local bone (LB), whether in addition to metallic implants or not, was applied. We made a comparison among those groups to evaluate the presence of differences in outcomes, such as fusion rate, hospital stay, follow-up extension (6, 12, 24, and 48 months), pseudarthrosis rate, and adverse events. Sixty-four studies were identified. LB presented significantly higher proportions of fusion rates (95.3% CI 89.7-98.7) compared to the AIC (88.6% CI 84.8-91.9), ALG (87.8% CI 80.8-93.4), and ALP (85.8% CI 75.7-93.5) study groups. Pseudarthrosis presented at a significantly lower pooled proportion of ALG studies (4.8% CI 0.1-15.7) compared to AIC (8.6% CI 4.2-14.2), ALP (7.1% CI 0.9-18.2), and LB (10.3% CI 1.8-24.5). ALP and AIC studies described significantly more cases of adverse events (80 events/404 patients and 860 events/2001 patients, respectively) compared to LB (20 events/311 patients) and ALG (73 events/459 patients). Most studies presented high risk-of-bias scores. Based on fusion rates and adverse events proportions, LB showed a superior trend among the graft cases we analyzed. However, our review revealed highly heterogeneous data and a need for more rigorous studies to better address and assist surgeons' choices of the best spinal grafts.
我们的研究旨在评估使用不同移植物进行脊柱融合的患者的结局差异，测量脊柱融合率、假关节率和不良事件的有效性。本系统评价和荟萃分析应用了系统评价和荟萃分析的首选报告项目，确定了 64 篇合格文章。主要纳入标准为接受脊柱融合术的成年患者，自体髂嵴（AIC）、同种异体移植物（ALG）、异体移植物（ALP；羟基磷灰石、rhBMP-2、rhBMP-7 或两者的组合）和局部骨（LB），无论是否与金属植入物一起使用。我们对这些组进行了比较，以评估在融合率、住院时间、随访时间延长（6、12、24 和 48 个月）、假关节率和不良事件等方面的差异。共确定了 64 项研究。LB 组的融合率（95.3%CI 89.7-98.7）显著高于 AIC（88.6%CI 84.8-91.9）、ALG（87.8%CI 80.8-93.4）和 ALP（85.8%CI 75.7-93.5）组。假关节在 ALG 研究中的比例明显较低（4.8%CI 0.1-15.7），而在 AIC（8.6%CI 4.2-14.2）、ALP（7.1%CI 0.9-18.2）和 LB（10.3%CI 1.8-24.5）组中。ALP 和 AIC 研究描述了更多的不良事件（80 例/404 例和 860 例/2001 例），而 LB（20 例/311 例）和 ALG（73 例/459 例）。大多数研究的偏倚风险评分较高。基于融合率和不良事件的比例，LB 在我们分析的移植物病例中显示出更好的趋势。然而，我们的综述显示数据高度异质，需要进行更严格的研究，以更好地解决并帮助外科医生选择最佳的脊柱移植物。
