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Meta-Analysis
. 2014 Jun 2;9(6):e97049.
doi: 10.1371/journal.pone.0097049. eCollection 2014.

A meta analysis of lumbar spinal fusion surgery using bone morphogenetic proteins and autologous iliac crest bone graft

Haifei Zhang  1 , Feng Wang  2 , Lin Ding  3 , Zhiyu Zhang  2 , Deri Sun  2 , Xinmin Feng  2 , Jiuli An  2 , Yue Zhu  1
Affiliations
Meta-Analysis

A meta analysis of lumbar spinal fusion surgery using bone morphogenetic proteins and autologous iliac crest bone graft

Haifei Zhang et al. PLoS One. .

Erratum in

  • PLoS One. 2014;9(12):e116460

Abstract

Background: Bone morphogenetic protein (BMPs) as a substitute for iliac crest bone graft (ICBG) has been increasingly widely used in lumbar fusion. The purpose of this study is to systematically compare the effectiveness and safety of fusion with BMPs for the treatment of lumbar disease.

Methods: Cochrane review methods were used to analyze all relevant randomized controlled trials (RCTs) published up to nov 2013.

Results: 19 RCTs (1,852 patients) met the inclusion criteria. BMPs group significantly increased fusion rate (RR: 1.13; 95% CI 1.05-1.23, P = 0.001), while there was no statistical difference in overall success of clinical outcomes (RR: 1.04; 95% CI 0.95-1.13, P = 0.38) and complications (RR: 0.96; 95% CI 0.85-1.09, p = 0.54). A significant reduction of the reoperation rate was found in BMPs group (RR: 0.57; 95% CI 0.42-0.77, p = 0.0002). Significant difference was found in the operating time (MD-0.32; 95% CI-0.55, -0.08; P = 0.009), but no significant difference was found in the blood loss, the hospital stay, patient satisfaction, and work status.

Conclusion: Compared with ICBG, BMPs in lumbar fusion can increase the fusion rate, while reduce the reoperation rate and operating time. However, it doesn't increase the complication rate, the amount of blood loss and hospital stay. No significant difference was found in the overall success of clinical outcome of the two groups.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. PRISMA flow diagram.
Figure 2
Figure 2. Risk of bias summary.
Figure 3
Figure 3. Forest plot-fusion rate.
Figure 4
Figure 4. Forest plot- overall clinical success.
Figure 5
Figure 5. Forest plot- complications.
Figure 6
Figure 6. Forest plot- reoperation rate.
Figure 7
Figure 7. Forest plot- operating time.
Figure 8
Figure 8. Forest plot- blood loss.
Figure 9
Figure 9. Forest plot- hospital stay.
Figure 10
Figure 10. Forest plot- patient satisfaction.
Figure 11
Figure 11. Forest plot- work status.
Figure 12
Figure 12. Forest plot- return to work status.
Figure 13
Figure 13. Funnel plot-fusion rate.
See this image and copyright information in PMC

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