A meta-analysis of risk factors for cage retropulsion after lumbar interbody fusion

English Keywords:Lumbar fusion  Cage retropulsion(CR)  Risk factors  Meta-analysis

English Abstract:

  【Abstract】 Objectives: To analyze the risk factors affecting the occurrence of cage retropulsion(CR) after lumbar interbody fusion surgery through systematic evaluation. Methods: By searching PubMed, Embase, Cochrane Library, Web of Science, CBM, CNKI, Wanfang and VIP databases, relevant literature related to the risk factors affecting CR after lumbar interbody fusion were collected from the inception of each database to April 2023. The study type was cohort study and case-control study, and the Newcastle-Ottawa scale(NOS) was used to evaluate the quality of the included studies. Basic information such as gender and age and CR related factors such as osteoporosis, endplate injury, pear-shaped disc, cage position, screw loosening, and so on were extracted. After assessing the risk of bias in the included studies, a meta-analysis was performed using Stata14.0 software. Results: A total of 16 relevant studies were included, among them, 15 articles were retrospective case-control studies and 1 article was a prospective cohort study, all of moderate or higher quality, with a quality score ≥7 points on average. The sample size was 12667 patients, and among which 326 cases developed CR(CR group) and 12341 cases didn′t developed CR(nCR group), with a CR incidence rate of 2.83%. The results of meta-analysis showed that gender(man)[odds ratio(OR)=1.264, 95% confidence interval(CI)(1.003-1.593), P=0.047], age[standardized mean difference(SMD)=0.237, 95%CI(0.054-0.419), P=0.011], osteoporosis[OR=3.126, 95%CI(1.040-9.401), P=0.042], endplate injury[OR=8.161, 95%CI(3.711-17.945), P=0.000], screw loosening[OR=7.978, 95%CI(3.487-18.255), P=0.000], pear-shaped disc[OR=6.037, 95%CI(2.381-15.305), P=0.000], and cage in poor position[OR=5.157, 95%CI(1.760-15.111), P=0.003] were the risk factors for CR after lumbar interbody fusion. Conclusions: Gender(man), age, osteoporosis, endplate injury, screw loosening, pear-shaped disc, and cage in poor position are closely related to CR after lumbar interbody fusion, and close attention needs to be paid to such patients to prevent complications of severe cage displacement during follow-up.