The safety and efficacy of anti-inflammatory-impregnated gelatin sponge in spine surgery: a systematic review and meta-analysis.

The purpose of this systematic review and meta-analysis is to evaluate the safety and efficacy of anti-inflammatory-impregnated gelatin sponges in spine surgeries. Gelatin sponges are increasingly used as delivery vehicles for anti-inflammatory and analgesic drugs during spine surgeries. However, concerns about their safety and efficacy persist. A comprehensive literature search was conducted to identify original research articles investigating the use of anti-inflammatory-impregnated gelatin sponges in spine surgeries from 2006 to 2024. Case reports, case series, animal studies, cadaveric studies, and abstract-only articles were excluded. The risk of bias was assessed using Cochrane Risk of Bias 2.0 (Cochrane, UK) for randomized controlled trials (RCTs) and the Newcastle Ottawa Scale (NOS) for observational studies. Meta-analysis was performed using Cochrane Review Manager Web. Thirteen studies (six RCTs, six cohort studies, and one case-control study) were included. Pooled analysis revealed a significant decrease in Visual Analog Scale (VAS) score for back pain (mean difference [MD], -0.62; 95% confidence intervals [CI], -0.78 to -0.46; p<0.00001), VAS score for leg pain (MD, -0.60; 95% CI, -0.87 to -0.34; p<0.00001), and length of hospital stay (MD, -0.99; 95% CI, -1.68 to -0.31; p=0.0004). Additionally, there was a significant increase in the Japanese Orthopedic Association score (MD, 0.98; 95% CI, 0.00 to 1.96; p=0.05). However, no significant difference was observed in the disability index (MD, -0.59; 95% CI, -1.88 to -0.70; p=0.37). The use of anti-inflammatory-impregnated gelatin sponges during spine surgeries decreases postoperative back pain and leg pain, reduces length of stay, and improves neurological function. Larger, prospective, randomized trials are required to obtain more robust evidence.