Systematic Review Of Benefits And Harms Of Spinal Fusion For Lumbar Degenerative Disc Disease

Objective: To assess the effect of spinal fusion for lumbar degenerative disc disease. Methods: RCTs were identified from specialized trials registered in Cochrane Back Group, the Cochrane library, additional electronic database including MEDLINE, EMBASE and CBM, reference list of articles, we hand searched some Chinese Journals, and also contacted manufacturers and researchers in the field. Data were extracted and evaluated by two reviewers independently of each other. Main results: 11 studies including a total of 1265 patients met the including criteria for the review, 7 studies of that compared with different lumbar fusions, Meta-analysis indicated that the arthrodesis was found to occur more reliably in patients treated with rhBMP-2-filled fusion cages than in controls treated with autogenous bone graft [RR=1.07, 95%CI (1.00, 1.15)]; ODI was found to improve more reliably in patients using autogenous bone graft than in controls using rhBMP-2 [WMD=11.26, 95%CI (3.36, 19.16)]; 3 studies of that compared circumferential fusion with artificial total disc replacement, The patients who received the disc replacement maybe have improvement in pain and function in early postoperative period, better satisfaction rates at month 6 after operation; eight studies described adverse effects. Conclusion: The arthrodesis was more reliably in patients treated with rhBMP-2-filled fusion cages than those who treated by autogenous bone graft, and ODI was more reliably in patients treated by autogenous bone graft than those who treated by rhBMP-2. More randomized controlled trials are needed to draw moredefinite conclusions. Artificial disc could preserve montion of diseased level at short-term follow-up. Protection of adjacent levels can only be assessed with completion of the multicenter study and long-term follow-up. More randomized controlled trials are needed to draw more definite conclusions.