Department of Orthopaedics Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Wang Lang Rd., Bangkok, 10700, Thailand.
Department of Orthopaedics, Bhumibol Adulyadej Hospital, Phahon Yothin Rd., Bangkok, 10220, Thailand.
BMC Musculoskelet Disord. 2024 Jun 3;25(1):433. doi: 10.1186/s12891-024-07531-w.
This study presents a systematic literature review and meta-analysis of pseudarthrosis risk factors following lumbar fusion procedures. The odds ratio (OR) and 95% confidence interval (95% CI) were used for outcome measurements. The objective of this study was to identify the independent risk factors for pseudarthrosis after lumbar spinal fusion, which is crucial for mitigating morbidity and reoperation. Systematic searches in PubMed, Embase, and Scopus (1990-July 2021) were conducted using specific terms. The inclusion criteria included prospective and retrospective cohorts and case‒control series reporting ORs with 95% CIs from multivariate analysis. The quality assessment utilized the Newcastle-Ottawa scale. Meta-analysis, employing OR and 95% CI, assessed pseudarthrosis risk factors in lumbar fusion surgery, depicted in a forest plot. Of the 568 abstracts identified, 12 met the inclusion criteria (9 retrospective, 2006-2021). The 17 risk factors were categorized into clinical, radiographic, surgical, and bone turnover marker factors. The meta-analysis highlighted two significant clinical risk factors: age (95% CI 1.02-1.11; p = 0.005) and smoking (95% CI 1.68-5.44; p = 0.0002). The sole significant surgical risk factor was the number of fused levels (pooled OR 1.35; 95% CI 1.17-1.55; p < 0.0001). This study identified 17 risk factors for pseudarthrosis after lumbar fusion surgery, emphasizing age, smoking status, and the number of fusion levels. Prospective studies are warranted to explore additional risk factors and assess the impact of surgery and graft type.
本研究对腰椎融合术后假关节形成的危险因素进行了系统的文献回顾和荟萃分析。采用比值比(OR)和 95%置信区间(95%CI)作为结果测量指标。本研究的目的是确定腰椎融合术后假关节形成的独立危险因素,这对于降低发病率和再次手术至关重要。在 PubMed、Embase 和 Scopus(1990 年-2021 年 7 月)中进行了系统检索,使用了特定的术语。纳入标准包括前瞻性和回顾性队列研究以及病例对照研究,报告了多元分析的 OR 和 95%CI。质量评估采用纽卡斯尔-渥太华量表。采用 OR 和 95%CI 的荟萃分析评估了腰椎融合手术中假关节形成的危险因素,并以森林图表示。在 568 篇摘要中,有 12 篇符合纳入标准(9 篇回顾性研究,2006-2021 年)。17 个危险因素分为临床、影像学、手术和骨转换标志物因素。荟萃分析强调了两个重要的临床危险因素:年龄(95%CI 1.02-1.11;p=0.005)和吸烟(95%CI 1.68-5.44;p=0.0002)。唯一显著的手术危险因素是融合节段的数量(合并 OR 1.35;95%CI 1.17-1.55;p<0.0001)。本研究确定了腰椎融合术后假关节形成的 17 个危险因素,强调了年龄、吸烟状况和融合节段的数量。需要前瞻性研究来探讨其他危险因素,并评估手术和移植物类型的影响。