J Korean Neurosurg Soc.  2020 Nov;63(6):673-680. 10.3340/jkns.2019.0185.

Comparison of Fusion Rate between Demineralized Bone Matrix versus Autograft in Lumbar Fusion : Meta-Analysis

• Han S
• Park B
• Lim JW
• Youm JY
• Choi SW
• Kim DH
• Ahn DK

• KMID: 2508596
• DOI: http://doi.org/10.3340/jkns.2019.0185

Abstract

The demineralized bone matrix (DBM) as the bone graft material to increase the fusion rate was widely used in spinal fusion. The current study aimed to compare the fusion rate of DBM to the fusion rate of autograft in lumbar spine fusion via meta-analysis of published literature. After systematic search, comparative studies were selected according to eligibility criteria. Checklist (risk of bias assessment tool for non-randomized study) was used to evaluate the risk of bias of the included nonrandomized controlled studies. The corresponding 95% confidence interval (95% CI) were calculated. We also used subgroup analysis to analyze the fusion rate of posterolateral lumbar fusion and lumbar interbody fusion. Eight studies were finally included in this meta-analysis. These eight studies included 581 patients. Among them, 337 patients underwent spinal fusion surgery using DBM (DBM group) and 204 patients underwent spinal fusion surgery with mainly autologous bone and without using DBM (control group). There was no significant differences of fusion rate between the two groups in posterolateral fusion analysis (risk ratio [RR], 1.03; 95% CI, 0.90–1.17; p=0.66) and interbody fusion analysis (RR, 1.13; 95% CI, 0.91–1.39; p=0.27). Based on the available evidence, the use of DBM with autograft in posterolateral lumbar spine fusion and lumbar interbody fusion showed a slightly higher fusion rate than that of autograft alone; however, there was no statistically different between two groups.

Keyword

Bone demineralization technique; Autografts; Lumbar vertebrae; Spinal fusion; Meta-analysis

Figure

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  Fig. 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram detailing the results of our meta-analysis of the medical literature.

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  Fig. 2. Risk of bias graph : review authors’ judgements about each risk of bias item presented as percentages across all included studies.

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  Fig. 3. Forest plots comparing fusion rate between DBM group and autobone group in lumbar posterolateral fusion surgery. CI : confidence interval, M-H : Mantel-Haenszel, DBM : demineralized bone matrix.

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  Fig. 4. Forest plots comparing fusion rate between DBM group and autobone group in lumbar interbody fusion surgery. CI : confidence interval, M-H : Mantel-Haenszel, DBM : demineralized bone matrix.

Reference

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