PDF(Pubmed)
Abstract：
METHODS: Guideline.
OBJECTIVE: To develop an international guideline (AOGO) about the use of osteobiologics in anterior cervical discectomy and fusion (ACDF) for treating degenerative spine conditions.
METHODS: The guideline development process was guided by AO Spine Knowledge Forum Degenerative (KF Degen) and followed the Guideline International Network McMaster Guideline Development Checklist. The process involved 73 participants with expertise in degenerative spine diseases and surgery from 22 countries. Fifteen systematic reviews were conducted addressing respective key topics and evidence was collected. The methodologist compiled the evidence into GRADE Evidence-to-Decision frameworks. Guideline panel members judged the outcomes and other criteria and made the final recommendations through consensus.
RESULTS: Five conditional recommendations were created. A conditional recommendation is about the use of allograft, autograft or a cage with an osteobiologic in primary ACDF surgery. Other conditional recommendations are about the use of osteobiologic for single- or multi-level ACDF, and for hybrid construct surgery. It is suggested that surgeons use other osteobiologics rather than human bone morphogenetic protein-2 (BMP-2) in common clinical situations. Surgeons are recommended to choose 1 graft over another or 1 osteobiologic over another primarily based on clinical situation, and the costs and availability of the materials.
CONCLUSIONS: This AOGO guideline is the first to provide recommendations for the use of osteobiologics in ACDF. Despite the comprehensive searches for evidence, there were few studies completed with small sample sizes and primarily as case series with inherent risks of bias. Therefore, high-quality clinical evidence is demanded to improve the guideline.
OBJECTIVE: To develop an international guideline (AOGO) about the use of osteobiologics in anterior cervical discectomy and fusion (ACDF) for treating degenerative spine conditions.
METHODS: The guideline development process was guided by AO Spine Knowledge Forum Degenerative (KF Degen) and followed the Guideline International Network McMaster Guideline Development Checklist. The process involved 73 participants with expertise in degenerative spine diseases and surgery from 22 countries. Fifteen systematic reviews were conducted addressing respective key topics and evidence was collected. The methodologist compiled the evidence into GRADE Evidence-to-Decision frameworks. Guideline panel members judged the outcomes and other criteria and made the final recommendations through consensus.
RESULTS: Five conditional recommendations were created. A conditional recommendation is about the use of allograft, autograft or a cage with an osteobiologic in primary ACDF surgery. Other conditional recommendations are about the use of osteobiologic for single- or multi-level ACDF, and for hybrid construct surgery. It is suggested that surgeons use other osteobiologics rather than human bone morphogenetic protein-2 (BMP-2) in common clinical situations. Surgeons are recommended to choose 1 graft over another or 1 osteobiologic over another primarily based on clinical situation, and the costs and availability of the materials.
CONCLUSIONS: This AOGO guideline is the first to provide recommendations for the use of osteobiologics in ACDF. Despite the comprehensive searches for evidence, there were few studies completed with small sample sizes and primarily as case series with inherent risks of bias. Therefore, high-quality clinical evidence is demanded to improve the guideline.
摘要：
方法：指南。
目的：制定一项关于在颈椎前路椎间盘切除和融合术（ACDF）中使用骨生物制剂治疗退行性脊柱疾病的国际指南（AOGO）。
方法：指南开发过程由AO脊柱知识论坛退化（KFDegen）指导，并遵循指南国际网络McMaster指南开发清单。该过程涉及来自22个国家的73名具有退行性脊柱疾病和手术专业知识的参与者。针对各自的关键主题进行了15次系统审查，并收集了证据。方法学家将证据汇编成GRADE证据到决策框架。准则小组成员对结果和其他标准进行了判断，并通过协商一致提出了最终建议。
结果：创建了五个有条件的建议。有条件的建议是关于同种异体移植的使用，原发性ACDF手术中的自体移植物或具有骨生物学的笼子。其他有条件的建议是关于使用骨生物学治疗单级或多级ACDF，和混合构造手术。建议外科医生在常见的临床情况下使用其他骨生物制剂而不是人骨形态发生蛋白2（BMP-2）。建议外科医生主要根据临床情况选择1个移植物而不是另一个移植物或1个骨生物学移植物而不是另一个移植物。以及材料的成本和可用性。
结论：本AOGO指南首次为ACDF中使用骨生物制剂提供了建议。尽管进行了全面的证据搜索，很少有小样本量完成的研究,主要是作为具有固有偏倚风险的病例系列.因此,需要高质量的临床证据来改进指南。
目的：制定一项关于在颈椎前路椎间盘切除和融合术（ACDF）中使用骨生物制剂治疗退行性脊柱疾病的国际指南（AOGO）。
方法：指南开发过程由AO脊柱知识论坛退化（KFDegen）指导，并遵循指南国际网络McMaster指南开发清单。该过程涉及来自22个国家的73名具有退行性脊柱疾病和手术专业知识的参与者。针对各自的关键主题进行了15次系统审查，并收集了证据。方法学家将证据汇编成GRADE证据到决策框架。准则小组成员对结果和其他标准进行了判断，并通过协商一致提出了最终建议。
结果：创建了五个有条件的建议。有条件的建议是关于同种异体移植的使用，原发性ACDF手术中的自体移植物或具有骨生物学的笼子。其他有条件的建议是关于使用骨生物学治疗单级或多级ACDF，和混合构造手术。建议外科医生在常见的临床情况下使用其他骨生物制剂而不是人骨形态发生蛋白2（BMP-2）。建议外科医生主要根据临床情况选择1个移植物而不是另一个移植物或1个骨生物学移植物而不是另一个移植物。以及材料的成本和可用性。
结论：本AOGO指南首次为ACDF中使用骨生物制剂提供了建议。尽管进行了全面的证据搜索，很少有小样本量完成的研究,主要是作为具有固有偏倚风险的病例系列.因此,需要高质量的临床证据来改进指南。
