Abstract：
OBJECTIVE: Nonunion and significant subsidence after anterior cervical discectomy and fusion (ACDF) are associated with poor clinical outcomes, which occasionally lead to revision surgery. Allograft and polyetheretherketone (PEEK) cages are the two most commonly used interbody spacer devices for ACDF. Although studies have been conducted to compare the efficacies of these two interbody materials, the question remains regarding the superiority of one over the other. Therefore, the authors conducted a systematic review and meta-analysis to compare nonunion, subsidence, and reoperation rates after ACDF using allograft and PEEK cages as interbody devices.
METHODS: In this systematic review and meta-analysis, the authors systematically searched the MEDLINE, EMBASE, and Cochrane Library databases for studies published prior to November 2023 that compared the efficacy and safety of allograft and PEEK cages for ACDF. A pooled analysis was designed to identify differences in nonunion, subsidence, and reoperation rates between the two interbody devices.
RESULTS: Ten studies involving 1462 patients (allograft, 852 patients; PEEK cage, 610 patients) were included. The pooled analysis demonstrated that allograft had a significantly lower rate of nonunion compared to that of PEEK cages (OR 0.33, 95% CI 0.14-0.79; p = 0.01). Furthermore, the reoperation rate due to nonunion was significantly higher with PEEK cages compared to that with allograft (OR 0.28, 95% CI 0.11-0.71; p < 0.01), whereas the reoperation rate due to overall causes did not display significant results (OR 0.38, 95% CI 0.11-1.29; p = 0.12). The incidence of significant subsidence (OR 0.66, 95% CI 0.28-1.55; p = 0.34) and the mean amount of subsidence (standard mean difference 0.03, 95% CI -0.42 to 0.47; p = 0.90) did not demonstrate significant differences between allograft and PEEK cages.
CONCLUSIONS: Overall, the current meta-analysis suggests the advantages of allograft over PEEK cages used for ACDF, due to an enhanced fusion rate and minimized revision risk, with no increase in the risk of subsidence.
METHODS: In this systematic review and meta-analysis, the authors systematically searched the MEDLINE, EMBASE, and Cochrane Library databases for studies published prior to November 2023 that compared the efficacy and safety of allograft and PEEK cages for ACDF. A pooled analysis was designed to identify differences in nonunion, subsidence, and reoperation rates between the two interbody devices.
RESULTS: Ten studies involving 1462 patients (allograft, 852 patients; PEEK cage, 610 patients) were included. The pooled analysis demonstrated that allograft had a significantly lower rate of nonunion compared to that of PEEK cages (OR 0.33, 95% CI 0.14-0.79; p = 0.01). Furthermore, the reoperation rate due to nonunion was significantly higher with PEEK cages compared to that with allograft (OR 0.28, 95% CI 0.11-0.71; p < 0.01), whereas the reoperation rate due to overall causes did not display significant results (OR 0.38, 95% CI 0.11-1.29; p = 0.12). The incidence of significant subsidence (OR 0.66, 95% CI 0.28-1.55; p = 0.34) and the mean amount of subsidence (standard mean difference 0.03, 95% CI -0.42 to 0.47; p = 0.90) did not demonstrate significant differences between allograft and PEEK cages.
CONCLUSIONS: Overall, the current meta-analysis suggests the advantages of allograft over PEEK cages used for ACDF, due to an enhanced fusion rate and minimized revision risk, with no increase in the risk of subsidence.
摘要：
目的：颈椎前路椎间盘切除融合术（ACDF）后骨不连和明显下沉与不良的临床结局有关，偶尔会导致翻修手术。同种异体移植物和聚醚醚酮(PEEK)笼是用于ACDF的两种最常用的椎体间间隔装置。尽管已经进行了研究来比较这两种椎体间材料的功效，问题仍然是关于一个比另一个优越。因此,作者进行了系统评价和荟萃分析，以比较骨不连，沉降,使用同种异体移植物和PEEK笼作为体间设备的ACDF后的再手术率。
方法：在本系统综述和荟萃分析中，作者系统地搜索了MEDLINE，EMBASE,和CochraneLibrary数据库，用于2023年11月之前发表的研究，比较了同种异体移植物和PEEK笼对ACDF的疗效和安全性。汇总分析旨在确定骨不连的差异，沉降,以及两个体间设备之间的再手术率。
结果：涉及1462例患者的十项研究（同种异体移植，852名患者；PEEK笼，610名患者）被包括在内。汇总分析表明，与PEEK笼相比，同种异体移植的骨不愈合率显着降低（OR0.33，95％CI0.14-0.79；p=0.01）。此外，PEEK笼与同种异体移植相比，由于骨不连引起的再手术率明显更高（OR0.28，95％CI0.11-0.71；p<0.01），而由于整体原因导致的再手术率没有显着结果（OR0.38，95％CI0.11-1.29；p=0.12）。显著沉降的发生率（OR0.66，95％CI0.28-1.55；p=0.34）和平均沉降量（标准平均差0.03，95％CI-0.42至0.47；p=0.90）在同种异体移植和PEEK笼之间没有显着差异。
结论：总体而言，目前的荟萃分析表明，同种异体移植优于用于ACDF的PEEK笼，由于提高了融合率和最小化的修订风险，没有增加沉降的风险。
方法：在本系统综述和荟萃分析中，作者系统地搜索了MEDLINE，EMBASE,和CochraneLibrary数据库，用于2023年11月之前发表的研究，比较了同种异体移植物和PEEK笼对ACDF的疗效和安全性。汇总分析旨在确定骨不连的差异，沉降,以及两个体间设备之间的再手术率。
结果：涉及1462例患者的十项研究（同种异体移植，852名患者；PEEK笼，610名患者）被包括在内。汇总分析表明，与PEEK笼相比，同种异体移植的骨不愈合率显着降低（OR0.33，95％CI0.14-0.79；p=0.01）。此外，PEEK笼与同种异体移植相比，由于骨不连引起的再手术率明显更高（OR0.28，95％CI0.11-0.71；p<0.01），而由于整体原因导致的再手术率没有显着结果（OR0.38，95％CI0.11-1.29；p=0.12）。显著沉降的发生率（OR0.66，95％CI0.28-1.55；p=0.34）和平均沉降量（标准平均差0.03，95％CI-0.42至0.47；p=0.90）在同种异体移植和PEEK笼之间没有显着差异。
结论：总体而言，目前的荟萃分析表明，同种异体移植优于用于ACDF的PEEK笼，由于提高了融合率和最小化的修订风险，没有增加沉降的风险。
