Porous tantalum metal implant versus bone autograft in cervical spine fusion: a Meta-analysis of effect and safety

English Keywords:Cervical spondylopathy  Porous metal implant  Tantalum metal  Bone autograft  Spinal fusion  Meta-analysis

English Abstract:

  【Abstract】 Objectives: To systematically compare porous tantalum metal implant and bone autograft in anterior cervical discectomy and fusion(ACDF) in cervical spondylopathy. Methods: 6 databases were searched for relevant randomized controlled trials(RCTs) that compared porous metal implants and bone autografts in cervical interbody fusion. Risks of bias in the RCTs were assessed by using the Cochrane Risk of Bias. Review Manager was used to analyze the data of operation time, blood loss, hospital stay, visual analogue scale (VAS), complication rate, fusion rate and satisfaction. Results: Five RCTs(n=254 patients) were identified according to our inclusion criteria. Two of the 5 studies were multiple-centers and the other 3 were mono-centers. The 5 RCTs described adequate methods of random sequence generation, but allocation concealment and blinding were described in one trial. 3 studies were as low risk of incomplete outcome data and 4 studies were as low risk of selective reporting. For the RCTs, there were significant differences in operation time[MD=-28.85, 95% CI(-47.09, -10.60), P=0.002], VAS[MD=-0.31, 95% CI(-0.43, -0.19), P<0.0001], and satisfaction[OR=2.20, 95% CI(1.06, 4.55), P=0.0035]. However, no significant difference was detected in blood loss [MD=-73.61, 95% CI(-217.72, 70.51), P=0.32], hospital stay[MD=-0.51, 95% CI(-1.08, 0.06), P=0.08], fusion rate[OR=0.63, 95% CI(0.15, 2.70), P=0.53] or complication rate[OR=0.25, 95% CI(0.04, 1.58), P=0.14]. Conclusions: Porous tantalum metal implant is as effective and safe as the bone autograft in cervical interbody fusion. However, the porous tantalum metal implants can decrease operation time and VAS and improve clinical satisfaction significantly.