Meta-analysis of application effect of 3D-printed artificial vertebral bodies in anterior cervical corpectomy and fusion

doi:10.12307/2026.698

Abstract

Abstract: OBJECTIVE: In recent years, many scholars have applied 3D-printed artificial vertebrae to anterior cervical vertebral subtotal vertebral resection and bone grafting fusion, but whether it is more effective than traditional titanium cages remains controversial. This study aims to systematically evaluate the effectiveness and safety of 3D-printed artificial vertebrae compared with traditional titanium cages as implants for anterior cervical corpectomy and fusion in the treatment of spondylosis.
METHODS: Databases such as CNKI, WangFang, CBM, VIP, PubMed, EMBASE, and The Cochrane Library were searched to collect the clinical research on the application of 3D-printed artificial vertebrae in anterior cervical corpectomy and fusion from the establishment of each database to February 2025. After screening the literature, extracting the data and evaluating the methodological quality of the included studies, the meta-analysis was performed using Rev Man 5.4.
RESULTS: (1) A total of 10 articles were included, including 2 prospective randomized controlled studies, 6 retrospective cohort studies, and 2 prospective cohort studies all of which were high-quality studies. The included literature comprised a total of 534 patients, including 273 in the 3D printing group and 261 in the control group. (2) The results of the meta-analysis showed that operation time [SMD=-1.13, 95%CI (-1.87, -0.39), P=0.003], the loss of disc height at the last follow-up [SMD=-3.01, 95%CI (-5.74, -0.29), P=0.03], the Neck Disability Index score (postoperative 3 months) [SMD=-0.34, 95%CI(-0.66, -0.03), P=0.03], the prosthesis subsidence rate [OR=0.19, 95%CI (0.11, 0.32), P < 0.000 01], and the incidence of postoperative dysphagia [OR=0.43, 95%CI (0.21, 0.90), P=0.03] were better in the 3D printing group than those in the control group, with significant differences. There was no statistically significant difference in the amount of intraoperative blood loss, hospital stay, postoperative Japanese Orthopaedic Association score, postoperative Visual Analog Scale score, postoperative Neck Disability Index score (6 months after surgery, at the last follow-up), and the rate of vertebral fusion between the two groups (P > 0.05).
CONCLUSION: Compared with traditional titanium cages, 3D-printed artificial vertebrae have obvious advantages in improving surgical efficiency, maintaining postoperative intervertebral height, reducing the incidence of postoperative swallowing discomfort and titanium cage subsidence.

Key words: cervical vertebra, 3D printing, artificial vertebra, anterior cervical corpectomy and fusion, meta-analysis

CLC Number:

Wu Ronghai, Zheng Zhouhang, Chen Huan, You Dongchun, Guo Weifeng, Liu Xingming, Zhang Yu . Meta-analysis of application effect of 3D-printed artificial vertebral bodies in anterior cervical corpectomy and fusion[J]. Chinese Journal of Tissue Engineering Research, 2026, 30(21): 5621-5628.

Figures/Tables 8

2.3.4 末次随访椎间隙丢失高度 3项研究报告了两组患者末次随访椎间隙丢失高度[8，10，15]，各研究间异质性较大(I2=97%，P < 0.000 01)，经敏感性分析未能消除异质性，选择随机效应模型进行Meta分析，结果显示3D打印组末次随访椎间隙丢失高度显著低于对照组，差异有显著性意义[SMD=-3.01，95%CI(-5.74，-0.29)，P=0.03]，见图5。 2.3.5 C2-7 Cobb角 6项研究报告了两组患者的C2-7 Cobb角[8-10，13，16-17]，根据随访时间进行亚组分析，评价两组患者在术后即刻、术后3个月、末次随访C2-7 Cobb角情况。其中3项研究报告了两组术后即刻C2-7 Cobb角[10，16-17]，各研究间异质性较大(I2= 61%，P=0.08)，经敏感性分析未能消除异质性，选择随机效应模型进行Meta分析，结果显示术后即刻3D打印组C2-7 Cobb角与对照组相近，差异无显著性意义[SMD=0.22，95%CI(-0.29，0.72)，P=0.40]。4项研究报告了两组术后3个月的C2-7 Cobb 角[10，13，16-17]，各研究间异质性较大(I2=93%，P < 0.000 01)，经敏感性分析未能消除异质性，选择随机效应模型进行Meta分析，结果显示术后3个月3D打印组C2-7 Cobb角与对照组相近，差异无显著性意义[SMD=1.09，95%CI(0.00，2.17)，P=0.05]。6项研究报告了两组术后末次随访C2-7 Cobb角[8-10，13，16-17]，各研究间异质性较大(I2=94%，P < 0.000 01)，经敏感性分析未能消除异质性，选择随机效应模型进行Meta分析，结果显示末次随访3D打印组C2-7 Cobb角与对照组相近，差异无显著性意义[SMD=0.87，95%CI(-0.10，1.84)，P=0.08]，见图6。 2.3.6 日本骨科协会评分 9项研究报告了两组的日本骨科协会评分[8-13，15-17]，根据随访时间进行亚组分析，评价两组患者在术后3，6个月及末次随访日本骨科协会评分情况。其中5项研究报告了两组术后3个月的日本骨科协会评分[9-10，13，16-17]，各研究间具有同质性(I2=0%，P=0.75)，选择固定效应模型进行Meta分析，结果显示术后3个月3D打印组日本骨科协会评分与对照组相近，差异无显著性意义[SMD=0.09，95%CI(-0.15，0.34)，P= 0.45]。2项研究报告了两组术后6个月的日本骨科协会评分[8-9]，各研究间异质性较小(I2=35%，P=0.22)，选择固定效应模型进行Meta分析，结果显示术后6个月3D打印组日本骨科协会评分与对照组相近，差异无显著性意义[SMD=0.38，95%CI(-0.04，0.79)，P=0.08]。8项研究报告了两组术后末次随访的日本骨科协会评分[9-13，15-17]，各研究间具有同质性(I2= 0%，P=0.66)，选择固定效应模型进行Meta分析，结果显示末次随访3D打印组日本骨科协会评分与对照组相近，差异无显著性意义[SMD=0.17，95%CI(-0.01，0.36)，P=0.07]，见图7。 2.3.7 目测类比评分 3项研究报告了两组患者的目测类比评分[10，13，17]，根据随访时间进行亚组分析，评价两组患者在术后3个月及末次随访时的目测类比评分情况。其中3项研究报告了两组术后3个月目测类比评分[10，13，17]，各研究间具有同质性(I2=0%，P=0.47)，选择固定效应模型进行Meta分析，结果显示术后3个月3D打印组目测类比评分与对照组相近，差异无显著性意义[SMD=-0.27，95%CI(-0.62，0.08)，P=0.13]。3项研究报告了两组术后末次随访目测类比评分[10，13，17]，各研究间具有同质性(I2=0%，P=0.50)，选择固定效应模型进行Meta分析，结果显示末次随访3D打印组目测类比评分与对照组相近，差异无显著性意义[SMD=-0.03，95%CI(-0.33，0.27)，P=0.84]，见图8。"

2.3.8 颈椎功能障碍指数 4项研究报告了两组患者的颈椎功能障碍指数[9-10，13，16]，根据随访时间进行亚组分析，评价两组患者在术后3，6个月及末次随访颈椎功能障碍指数情况。其中4项研究报告了两组术后3个月的颈椎功能障碍指数[9-10，13，16]，各研究间异质性较小(I2=32%，P= 0.22)，选择固定效应模型进行Meta分析，结果显示术后3个月3D打印组颈椎功能障碍指数显著低于对照组，差异有显著性意义[SMD=-0.34，95%CI(-0.66，-0.03)，P=0.03]。1项研究报告了两组术后6个月的日本骨科协会评分[9]，两组日本骨科协会评分相比差异无显著性意义(P=0.27)。4项研究报告了两组术后末次随访的颈椎功能障碍指数[9-10，13，16]，各研究间异质性较大(I2=93%，P < 0.000 01)，经敏感性分析未能消除异质性，选择随机效应模型进行Meta分析，结果显示末次随访3D打印组颈椎功能障碍指数与对照组相近，差异无显著性意义[SMD=-0.80，95%CI(-1.86，0.27)，P=0.14]，见图9。 2.3.9 假体塌陷率 10项研究报告了两组患者的假体塌陷率[8-17]，各研究间异质性较小(I2=25%，P=0.22)，选择固定效应模型进行Meta分析，结果显示3D打印组假体塌陷率显著低于对照组，差异有显著性意义[OR=0.19，95%CI(0.11，0.32)，P < 0.000 01]，见图10。 2.3.10 椎体融合率 9项研究报告了两组患者的椎体融合率[9-17]，各研究间具有同质性(I2=0%，P=0.67)，选择固定效应模型进行Meta分析，结果显示3D打印组椎体融合率与对照组相近，差异无显著性意义[OR=1.02，95%CI(0.20，5.27)，P=0.98]，见图11。 2.3.11 术后吞咽不适发生率 5项研究报告了两组患者术后吞咽不适发生率[9，11-12，14，17]，各研究间具有同质性(I2=0%，P=0.54)，选择固定效应模型进行Meta分析，结果显示3D打印组术后吞咽不适发生率显著低于对照组，差异有显著性意义[OR=0.43，95%CI(0.21，0.90)，P=0.03]，见图12。"

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