Purpose

A variety of alternative grafts to autologous iliac crest bone (ICBG) have been developed for lumbar spondylodesis, due to frequent complications following ICBG harvest. The optimal alternative graft to ICBG, however, remains elusive till now. The purpose of this study was to compare the efficacy and safety of fusion materials in lumbar degeneration diseases and to provide a ranking spectrum of the grafts.

Methods

Randomized controlled trials (RCTs) comparing different bone grafts in lumbar arthrodesis were eligible for inclusion. A network meta-analysis was performed for endpoints including fusion rate and incidence of adverse events.

Results

Twenty-seven RCTs involving 2488 patients and 13 available interventions were included. rhBMP-2 provided the highest fusion rate, being significantly superior to that of ICBG (OR = 0.21, p < 0.001), autograft local bone (ALB) (OR = 0.18, p = 0.022), rhBMP-7 (OR = 0.15, p < 0.001), allograft (OR = 0.13, p = 0.009), and DBM + ALB (OR = 0.07, p = 0.048). The treatment efficacy of allograft could be significantly enhanced by bone marrow concentrate (BMC) supplying (OR = 0.16, p = 0.010). ICBG ranks second on the frequency of complications, which is significantly higher than that of allograft (OR = 0.14, p = 0.041) and ALB (OR = 0.14, p = 0.030). All of the other comparisons showed similar efficacy and safety profiles between groups.

Conclusion

Ranking spectrums of the efficacy and safety for various bone grafts were provided graphically. Though rhBMP-2 was of the highest success rate, the application should be taken with proper caution because of the widely proposed life-threatening adverse events. ALB, ALB plus synthetic ceramic materials and allograft mixed with BMC were also proved to be potentially effective alternative graft to ICBG.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.

中文翻译：

---

腰椎融合术中骨替代物的疗效和安全性：随机对照试验的系统评价和网络荟萃分析。

目的

由于ICBG收获后经常发生并发症，已开发出多种自体auto骨（ICBG）替代移植物用于腰椎病。但是，迄今为止，ICBG的最佳替代移植物仍然难以捉摸。这项研究的目的是比较融合材料在腰椎退行性疾病中的功效和安全性，并提供移植物的分级谱图。

方法

比较在腰椎关节固定术中不同骨移植物的随机对照试验（RCT）符合纳入条件。对端点进行了网络荟萃分析，包括融合率和不良事件的发生率。

结果

包括2488例患者的27项RCT和13种可用的干预措施。rhBMP-2融合率最高，显着优于ICBG（OR = 0.21，p  <0.001），自体移植局部骨（ALB）（OR = 0.18，p  = 0.022），rhBMP-7（OR = 0.15，p  <0.001），同种异体移植（OR = 0.13，p  = 0.009）和DBM + ALB（OR = 0.07，p  = 0.048）。骨髓浓缩液（BMC）的供应可以显着提高同种异体移植的治疗效果（OR = 0.16，p  = 0.010）。ICBG在并发症发生频率上排名第二，显着高于同种异体移植（OR = 0.14，p  = 0.041）和ALB（OR = 0.14，p = 0.030）。所有其他比较均显示各组之间相似的功效和安全性。

结论

图形化地提供了各种骨移植物的功效和安全性的排名谱。尽管rhBMP-2成功率最高，但是由于广泛提出了威胁生命的不良事件，因此应谨慎使用。还证明了ALB，ALB加合成陶瓷材料以及与BMC混合的同种异体移植物是ICBG的潜在有效替代移植物。

图形摘要

这些幻灯片可以在电子补充材料下找到。