Abstract：
OBJECTIVE: The role of interbodies in lumbar arthrodesis has been insufficiently supported by evidence, impacting clinical decision-making and occasionally insurance coverage. This study aimed to compare clinical and radiological outcomes between lumbar arthrodesis with a synthetic interbody spacer (cage) versus structural bone graft alone (autograft or allograft) in patients with degenerative spine disease.
METHODS: A systematic review of the literature was performed to identify studies directly comparing outcomes of lumbar interbody arthrodesis with and without interbody cage use. The outcomes of individual studies were synthesized in meta-analyses using random-effects models.
RESULTS: Twenty studies with 1508 patients (769 with an interbody cage and 739 without an interbody cage) were included. Interbody cage placement was associated with a significantly greater increase in disc height after surgery (4.0 mm vs 3.4 mm, p < 0.01). There was a significantly greater reduction of back pain (visual analog scale [VAS] score) in cases in which an interbody cage was used (5.4 vs 4.7, p = 0.03). Fusion rates were 5.5% higher in the cage group (96.3% vs 90.8%) and reached statistical significance (p = 0.03). No statistically significant differences were identified between the two groups regarding all-cause reoperation rates, complication rates, or improvement in Oswestry Disability Index score or leg pain (VAS score).
CONCLUSIONS: These results suggest that implantation of an interbody cage is associated with higher rates of fusion, more effective maintenance of disc height, and greater improvement of back pain. This study underlines the clinical value of interbody cages in lumbar arthrodesis for patients with degenerative spine disease.
METHODS: A systematic review of the literature was performed to identify studies directly comparing outcomes of lumbar interbody arthrodesis with and without interbody cage use. The outcomes of individual studies were synthesized in meta-analyses using random-effects models.
RESULTS: Twenty studies with 1508 patients (769 with an interbody cage and 739 without an interbody cage) were included. Interbody cage placement was associated with a significantly greater increase in disc height after surgery (4.0 mm vs 3.4 mm, p < 0.01). There was a significantly greater reduction of back pain (visual analog scale [VAS] score) in cases in which an interbody cage was used (5.4 vs 4.7, p = 0.03). Fusion rates were 5.5% higher in the cage group (96.3% vs 90.8%) and reached statistical significance (p = 0.03). No statistically significant differences were identified between the two groups regarding all-cause reoperation rates, complication rates, or improvement in Oswestry Disability Index score or leg pain (VAS score).
CONCLUSIONS: These results suggest that implantation of an interbody cage is associated with higher rates of fusion, more effective maintenance of disc height, and greater improvement of back pain. This study underlines the clinical value of interbody cages in lumbar arthrodesis for patients with degenerative spine disease.
摘要：
目的：椎体间在腰椎关节固定术中的作用没有得到充分的证据支持，影响临床决策和偶尔的保险范围。这项研究旨在比较退行性脊柱疾病患者使用合成椎间垫片（cage）与单纯结构性骨移植（自体移植或同种异体移植）的腰椎关节固定术之间的临床和放射学结果。
方法：对文献进行了系统综述，以确定直接比较使用和不使用椎间固定架的腰椎椎间关节固定术结果的研究。使用随机效应模型在荟萃分析中综合了各个研究的结果。
结果：纳入了20项研究，涉及1508例患者（769例使用椎间融合器，739例没有椎间融合器）。椎间融合器的放置与手术后椎间盘高度的增加有关（4.0mmvs3.4mm，p<0.01)。在使用椎间笼子的情况下，背痛的减少（视觉模拟量表[VAS]评分）显着增加（5.4vs4.7，p=0.03）。笼组的融合率高5.5％（96.3％vs90.8％），具有统计学意义（p=0.03）。两组全因再手术率无统计学差异，并发症发生率,或改善Oswestry残疾指数评分或腿部疼痛（VAS评分）。
结论：这些结果表明植入椎间融合器与更高的融合率相关，更有效地维护光盘高度，和更大的改善背痛。这项研究强调了腰椎关节固定术中椎间融合器对退行性脊柱疾病患者的临床价值。
方法：对文献进行了系统综述，以确定直接比较使用和不使用椎间固定架的腰椎椎间关节固定术结果的研究。使用随机效应模型在荟萃分析中综合了各个研究的结果。
结果：纳入了20项研究，涉及1508例患者（769例使用椎间融合器，739例没有椎间融合器）。椎间融合器的放置与手术后椎间盘高度的增加有关（4.0mmvs3.4mm，p<0.01)。在使用椎间笼子的情况下，背痛的减少（视觉模拟量表[VAS]评分）显着增加（5.4vs4.7，p=0.03）。笼组的融合率高5.5％（96.3％vs90.8％），具有统计学意义（p=0.03）。两组全因再手术率无统计学差异，并发症发生率,或改善Oswestry残疾指数评分或腿部疼痛（VAS评分）。
结论：这些结果表明植入椎间融合器与更高的融合率相关，更有效地维护光盘高度，和更大的改善背痛。这项研究强调了腰椎关节固定术中椎间融合器对退行性脊柱疾病患者的临床价值。
