Do Osteobiologics Augment Fusion in Anterior Cervical Discectomy and Fusion Surgery Performed With Mechanical Interbody Devices (Polyether ether ketone, Carbon Fiber, Metal Cages) and is the Fusion Rate Comparable to that With Autograft? A Systematic Review

Author:

Arun-Kumar Viswanadha1ORCID,Corluka Stipe23ORCID,Buser Zorica45ORCID,Wu Yabin6ORCID,El-Sharkawi Mohammad7ORCID,Carazzo Charles André8,Ponugoti Nikhil9,Wang Jeffrey C.1011,Meisel Hans Jörg12ORCID,

Affiliation:

1. Reva Spine Centre, Visakhapatnam, India

2. Spinal Surgery Division, Department of Traumatology, University Hospital Centre Sestre Milosrdnice, Zagreb, Croatia

3. Department of Anatomy and Physiology, University of Applied Health Sciences, Zagreb, Croatia

4. Gerling Institute, Brooklyn, NY, USA

5. Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA

6. Research Department, AO Spine, AO Foundation, Davos, Switzerland

7. Professor of Orthopaedic and Trauma Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt

8. Professor of Neurosurgery, Faculty of Medicine, Passo Fundo University, Passo Fundo, Brazil

9. Orthopaedic Registrar, Hampshire Hospital NHS Foundation Trust, Hampshire, UK

10. USC Spine Center, Los Angeles, CA, USA

11. Department of Orthopaedic Surgery and Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

12. Department of Neurosurgery, BG Klinikum Bergmannstrost Halle, Germany

Abstract

Study design Systematic Review of the Literature. Objective The purpose of this study was to perform a systematic review describing fusion rates for anterior cervical discectomy and fusion (ACDF) using autograft vs various interbody devices augmented with different osteobiologic materials. Methods A systematic review limited to the English language was performed in Medline, Embase and Cochrane library using Medical Subject Heading (MeSH) terms. Studies that evaluated fusion after ACDF using autografts and osteobiologics combined with PEEK, carbon fibre, or metal cages were searched for. Articles in full text that met the criteria were included in the review. The main outcomes evaluated were the time taken to merge, the definition of the fusion assessment, and the modality of the fusion assessment. The risk of bias of each article was assessed by the MINORS score or ROB 2.0 depending on the randomisation process. Results The total number of references reviewed was six hundred and eighty-two. After applying the inclusion criteria, 54 were selected for the retrieval of the full text. Eight studies were selected and included for final analysis in this study. Fusion rates were reported between 83.3% and 100% for autograft groups compared to 46.5% and 100% for various interbody device/osteobiological combinations. The overall quality of the evidence in all radiographic fusion studies was considered insufficient due to a serious risk of bias. Conclusion Mechanical interbody devices augmented with osteobiologics performed similarly to autografts in terms of reliability and efficacy. Their time to fusion and fusion rate were comparable to autografts at the end of the final follow-up.

Publisher

SAGE Publications

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