PDF(Pubmed)
Abstract：
METHODS: Systematic review.
OBJECTIVE: The study\'s primary objective was to determine how osteobiologic choice affects fusion rates in patients undergoing anterior cervical discectomy and fusion (ACDF). The study\'s secondary objectives were to 1) determine the optimal timing of fusion assessment following ACDF and 2) determine if osteobiologic type affects the timing and optimal modality of fusion assessment.
METHODS: A systematic search of PubMed/MEDLINE was conducted for literature published from 2000 through October 2020 comparing anterior fusion in the cervical spine with various osteobiologics. Both comparative studies and case series of ≥10 patients were included.
RESULTS: A total of 74 studies met the inclusion criteria. Seventeen studies evaluated the efficacy of autograft on fusion outcomes, and 23 studies assessed the efficacy of allograft on fusion outcomes. 3 studies evaluated the efficacy of demineralized bone matrix, and seven assessed the efficacy of rhBMP-2 on fusion outcomes. Other limited studies evaluated the efficacy of ceramics and bioactive glasses on fusion outcomes, and 4 assessed the efficacy of stem cell products. Most studies utilized dynamic radiographs for the assessment of fusion. Overall, there was a general lack of supportive data to determine the optimal timing of fusion assessment meaningfully or if osteobiologic type influenced fusion timing.
CONCLUSIONS: Achieving fusion following ACDF appears to remain an intricate interplay between host biology and various surgical factors, including the selection of osteobiologics. While alternative osteobiologics to autograft exist and may produce acceptable fusion rates, limitations in study methodology prevent any definitive conclusions from existing literature.
OBJECTIVE: The study\'s primary objective was to determine how osteobiologic choice affects fusion rates in patients undergoing anterior cervical discectomy and fusion (ACDF). The study\'s secondary objectives were to 1) determine the optimal timing of fusion assessment following ACDF and 2) determine if osteobiologic type affects the timing and optimal modality of fusion assessment.
METHODS: A systematic search of PubMed/MEDLINE was conducted for literature published from 2000 through October 2020 comparing anterior fusion in the cervical spine with various osteobiologics. Both comparative studies and case series of ≥10 patients were included.
RESULTS: A total of 74 studies met the inclusion criteria. Seventeen studies evaluated the efficacy of autograft on fusion outcomes, and 23 studies assessed the efficacy of allograft on fusion outcomes. 3 studies evaluated the efficacy of demineralized bone matrix, and seven assessed the efficacy of rhBMP-2 on fusion outcomes. Other limited studies evaluated the efficacy of ceramics and bioactive glasses on fusion outcomes, and 4 assessed the efficacy of stem cell products. Most studies utilized dynamic radiographs for the assessment of fusion. Overall, there was a general lack of supportive data to determine the optimal timing of fusion assessment meaningfully or if osteobiologic type influenced fusion timing.
CONCLUSIONS: Achieving fusion following ACDF appears to remain an intricate interplay between host biology and various surgical factors, including the selection of osteobiologics. While alternative osteobiologics to autograft exist and may produce acceptable fusion rates, limitations in study methodology prevent any definitive conclusions from existing literature.
摘要：
方法：系统评价。
目的：本研究的主要目的是确定骨生物学选择如何影响颈前路椎间盘切除和融合术（ACDF）患者的融合率。该研究的次要目标是1）确定ACDF后融合评估的最佳时机，以及2）确定骨生物学类型是否会影响融合评估的时机和最佳方式。
方法：对PubMed/MEDLINE进行了系统检索，以查找2000年至2020年10月发表的比较颈椎前路融合与各种骨生物学的文献。纳入了≥10例患者的比较研究和病例系列。
结果：共有74项研究符合纳入标准。17项研究评估了自体移植对融合结果的疗效，23项研究评估了同种异体移植对融合结局的疗效。3项研究评估了脱矿质骨基质的功效，7人评估了rhBMP-2对融合结局的疗效。其他有限的研究评估了陶瓷和生物活性玻璃对融合结果的功效，和4评估干细胞产品的功效。大多数研究利用动态射线照片来评估融合。总的来说,一般缺乏支持性数据来确定有意义的融合评估的最佳时机,或确定骨生物学类型是否影响融合时机.
结论：在ACDF后实现融合似乎仍然是宿主生物学和各种手术因素之间复杂的相互作用，包括骨生物制剂的选择。虽然存在替代自体移植物的骨生物学，并且可以产生可接受的融合率，研究方法的局限性阻碍了现有文献中的任何明确结论。
目的：本研究的主要目的是确定骨生物学选择如何影响颈前路椎间盘切除和融合术（ACDF）患者的融合率。该研究的次要目标是1）确定ACDF后融合评估的最佳时机，以及2）确定骨生物学类型是否会影响融合评估的时机和最佳方式。
方法：对PubMed/MEDLINE进行了系统检索，以查找2000年至2020年10月发表的比较颈椎前路融合与各种骨生物学的文献。纳入了≥10例患者的比较研究和病例系列。
结果：共有74项研究符合纳入标准。17项研究评估了自体移植对融合结果的疗效，23项研究评估了同种异体移植对融合结局的疗效。3项研究评估了脱矿质骨基质的功效，7人评估了rhBMP-2对融合结局的疗效。其他有限的研究评估了陶瓷和生物活性玻璃对融合结果的功效，和4评估干细胞产品的功效。大多数研究利用动态射线照片来评估融合。总的来说,一般缺乏支持性数据来确定有意义的融合评估的最佳时机,或确定骨生物学类型是否影响融合时机.
结论：在ACDF后实现融合似乎仍然是宿主生物学和各种手术因素之间复杂的相互作用，包括骨生物制剂的选择。虽然存在替代自体移植物的骨生物学，并且可以产生可接受的融合率，研究方法的局限性阻碍了现有文献中的任何明确结论。
