Efficacy Of RhBMP-2Complex In Lumbar Interbody Fusion: A Meta-analysis

BackgroundLumbar interbody fusion has been increasingly widely used in lumbar interbodyfusion in the treatment of patients with symptomatic degenerative disc disease (DDD).We always choice the autogenous iliac crest bone graft (ICBG) for the implant as ithaving better fusion rate and less rejection, however, it also has many intraoperativeand postoperative complication, and exists the possibility of bone delayed union orununion. However, recent studies have indicated that the recombinant human bonemorphogenetic protein-2(rhBMP-2) could induce generation，and rhBMP-2complex(Absorbable Collagen Sponge and Cage) could substitute the ICBG. There were somereports about the efficacy of rhBMP-2complex comparing the ICBG, however aimingat lumbar interbody fusion, especially the fusion in the treatment of patients withsingle segmental DDD, it need Evidence-based medicine method which has largersample size and higher study quality to compare rhBMP-2complex with ICBG.MethodsRandomized controlled trials that compared rhBMP-2with ICBG for lumbarfusion in the treatment of patients with adult single segmental DDD were identified bycomputer and manual searching from January2000to December2014. The risk ofbias and clinical relevance of the included studies were assessed. Methodologicalquality, clinical relevance and Publication bias of include studies are Standardizedassessed according to the criteria and the instructions recommended by the CochraneBack Review Group (CBRG). Comparison item：perioperative period（operationtime， blood loss, hospital stay），24months follow-up（fusion failure，ODIimprovement, reoperation, patient satisfaction, return to work）RevMan5.0softwarewas used for data analysis. ResultsSix randomized controlled trials (577patients) met the inclusion criteria. Allstudies have high Methodological quality (≥6scores). According the perioperativeperiod and24months follow-up results, meta analysis showed that:1. The use ofrhBMP-2complex significantly shortened operation time (P＜0.00001,DM=-0.39,95%CI=-0.45,-0.33) and hospital stay (P＜0.0001,DM=-0.30,95%CI=-0.44,-0.16) and reduced blood loss (P＜0.00001,DM=-53.59,95%CI=-70.04,-37.13) and reoperation (P=0.01,RR=0.52,95%CI=0.32,0.87).2.Compared with ICBG, the use of rhBMP-2significantly decreased the risk of fusionfailure at24months(P＜0.00001,RR=0.20,95%CI=0.11,0.39).3. There was nostatistical difference in clinical improvement on the Oswestry Disability Index,although a favorable trend in the rhBMP-2group was found (P=0.53,RR=0.75,95%CI=0.51,1.09).4. There was no statistical difference in patient satisfaction (P=0.11,RR=1.07,95%CI=0.97,1.18) and return to work (P=0.36,RR=1.18,95%CI=0.98,1.42) at24months. Subgroup analyses stratified by the type of surgicalprocedure yielded similar results. Because of different format of complication, we justlist and analysis.ConclusionRhBMP-2complex in the treatment of patients with single segmental DDD wassuperior to the ICBG for achieving fusion success, shortening operation time andhospital stay, reduced blood loss and avoiding reoperation. This study preliminaryevidence that rhBMP-2complex has good efficacy for the lumbar interbody fusion,and substitution for the ICBG. Because of less RCT cases and respective higher caseweight, the conclusion need more RCT which has large sample and strict design toconfirm further.