Rocky Vista University College of Osteopathic Medicine, Parker, CO, USA.
Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Neurosurg Rev. 2024 Oct 15;47(1):796. doi: 10.1007/s10143-024-02769-3.
To evaluate the impact that adjuvant therapies like radiotherapy, chemotherapy, and immunotherapy have on osteobiologic properties and bony regeneration in patients with metastatic spine disease (MSD) undergoing spinal fusion surgery.
PubMed and ClinicalTrials.gov searches were performed. MSD patients undergoing fusion surgery with an osteobiologic and radiotherapy, chemotherapy and/or immunotherapy were included. Demographics, primary tumor, surgery, adjuvant treatments, osteobiologic type, fusion rates with scoring criteria, hardware failure, reoperation rates, follow-up, and survival were extracted. 1487 studies were screened, 20 included.
585 patients (464 with MSD) had fusion rates ranging from 17.9 to 100%. In the setting of radiotherapy, fusion rates of 10 studies using autologous bone graft (autograft), 5 studies using allogenic bone graft (allograft), 5 studies using combination autograft/allograft, 4 studies using biomaterial scaffolds (BMS), 3 studies using demineralized bone matrices (DBM), and 1 study using growth factors (GF), were 50-100%, 17.9-100%, 57.8-100%, 52.9-100%, 20-100%, and 100%, respectively. A higher incidence of fusion in patients with autograft or allograft receiving stereotactic body radiotherapy (SBRT) at lower biologically effective doses (BED) and at least 1-month postoperatively was noted. Chemotherapy had no impact on fusion. No studies evaluated the impact of immunotherapy on fusion.
SBRT at lower doses given greater than 1-month postoperatively may enhance bony fusion in patients receiving autograft, allograft, or autograft/allograft. Chemotherapy may delay bony fusion without affecting overall fusion rates. Preclinical studies suggest immunotherapy may prevent osteolysis and promote osteogenesis, but no studies have yet evaluated the clinical impact of these findings on spinal fusion. Further research is needed on osteobiologics in bony regeneration in the MSD population.
评估辅助治疗（如放疗、化疗和免疫治疗）对接受脊柱融合手术的转移性脊柱疾病（MSD）患者的骨生物学特性和骨再生的影响。
进行了 PubMed 和 ClinicalTrials.gov 检索。纳入接受融合手术且接受骨生物学治疗以及放疗、化疗和/或免疫治疗的 MSD 患者。提取人口统计学、原发肿瘤、手术、辅助治疗、骨生物学类型、根据评分标准的融合率、内植物失败、再次手术率、随访和生存率等数据。筛选了 1487 项研究，纳入了 20 项研究。
585 例患者（464 例患有 MSD）的融合率为 17.9%至 100%。在放疗的背景下，使用自体骨移植物（自体移植物）的 10 项研究、使用同种异体骨移植物（同种异体移植物）的 5 项研究、使用自体移植物/同种异体移植物联合的 5 项研究、使用生物材料支架（BMS）的 4 项研究、使用脱矿物质骨基质（DBM）的 3 项研究和使用生长因子（GF）的 1 项研究的融合率分别为 50%-100%、17.9%-100%、57.8%-100%、52.9%-100%、20%-100%和 100%。在接受较低生物有效剂量（BED）的立体定向体部放疗（SBRT）且术后至少 1 个月的患者中，自体移植物或同种异体移植物的融合发生率更高。化疗对融合没有影响。没有研究评估免疫治疗对融合的影响。
术后至少 1 个月给予较低剂量的 SBRT 可能会增强接受自体移植物、同种异体移植物或自体移植物/同种异体移植物的患者的骨融合。化疗可能会延迟骨融合，但不会影响整体融合率。临床前研究表明免疫疗法可能预防骨溶解并促进成骨，但尚无研究评估这些发现对脊柱融合的临床影响。需要进一步研究 MSD 人群中骨生物学在骨再生中的作用。
