Interbody fusion cage and autograft fusion for lumbar spondylolisthesis: A meta-analysis

doi:10.3969/j.issn.2095-4344.2013.52.017

Abstract

Abstract:

BACKGROUND: The surgical treatment for lumbar spondylolisthesis has developed from posterior lumbar interbody fusion to bone graft fusion and internal fixation, which is widely applied in clinics.
OBJECTIVE: To systemically evaluate the clinical therapeutic efficacy of lumbar interbody fusion between cage and autograft alone for treating lumbar spondylolisthesis, and to provide evidence-based measures for clinical treatment.

METHODS: An online search of China Biological Medicine disk, PubMed, PQDT, Cochrane Library, Springerlink,MEDLINE, and EMBASE databases was performed from March 1990 to December 2012. In addition, we hand-based searched Chinese Journal of Spine and Spinal Cord, Chinese Journal of Orthopaedics, Orthopedic Journal of China, and Chinese Journal of Reparative and Reconstructive Surgery for clinical studies about the comparison of lumbar interbody fusion between cage and alone-autograft for treating lumbar spondylolisthesis. The selected trails were screened out according to the criterion of inclusion and exclusion, and quality was evaluated. RevMan 5.1.5 software (Cachrane Library) was used for Meta analysis. The following indexes were used to compare the results: intraoperative blood loss, operative time, height of vertebral space, fusion rate, excellent and good rate, complication rate and operation fee.

RESULTS AND CONCLUSION: One prospective study and eight case-controlled retrospective studies were included, involving 585 patients. The results of Meta-analysis indicated that compared with autograft fusion, cage fusion showed no differences in operative time [MD=7.19, 95 %CI (-34.39, 48.77), P=0.73], intraoperative blood loss [MD=21.34, 95%CI (-139.56, 182.24), P=0.79], excellent and good rate [OR=1.53, 95%CI (0.93, 2.53), P=0.09], and complication rate [OR=0.94, 95%CI (0.51, 1.75), P=0.85]. The fusion rate was higher in cage fusion compared with autogaft fusion [OR=1.87, 95%CI (1.08, 3.25), P=0.03]. Cage fusion better maintained loss of the height of vertebral space [MD=0.03, 95%CI (0.01, 0.04)] and a higher operation fee [MD=0.92, 95%CI (0.30, 1.82), P=0.004] than autograft fusion. Both cage and autograft fusion are effective for treating lumbar spondylolisthesis. Compared with autograft fusion, cage fusion has the higher fusion rate and higher operation fee, and significantly maintains the height of vertebral space. There was no difference in operative time, blood loss, excellent and good rate, and complication rate. Because of the lack of prospective articles and small sample size, large-sized randomized controlled studies are urgently needed to provide evidence.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: spondylolysis, lumbar vertebrae, spinal fusion, intervertebral disc, bone transplantation, internal fixators

CLC Number:

R318

Mardan•Mamat, Sheng Wei-bin, Alim•Abdurexit, Guo Hai-long, Deng Qiang, Liang Wei-dong, Mamatkirmulla•Tursunjan. Interbody fusion cage and autograft fusion for lumbar spondylolisthesis: A meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(52): 9041-9048.

Figures/Tables 6

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