Influence of instrumentation type on outcomes after surgical management of spondylodiscitis: a systematic review and meta-analysis.

Autor: Maddy KS; Department of Neurological Surgery, University of Miami Miller School of Medicine, 1600 NW 10th Ave Miami, Miami, FL, 33136, USA. Ksm129@med.miami.edu., Tigre JY; Department of Neurological Surgery, University of Miami Miller School of Medicine, 1600 NW 10th Ave Miami, Miami, FL, 33136, USA., Lu VM; Department of Neurological Surgery, University of Miami Miller School of Medicine, 1600 NW 10th Ave Miami, Miami, FL, 33136, USA., Costello MC; Department of Neurological Surgery, University of Miami Miller School of Medicine, 1600 NW 10th Ave Miami, Miami, FL, 33136, USA., Errante EL; Department of Neurological Surgery, University of Miami Miller School of Medicine, 1600 NW 10th Ave Miami, Miami, FL, 33136, USA., Levi AD; Department of Neurological Surgery, University of Miami Miller School of Medicine, 1600 NW 10th Ave Miami, Miami, FL, 33136, USA.; The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA., Burks SS; Department of Neurological Surgery, University of Miami Miller School of Medicine, 1600 NW 10th Ave Miami, Miami, FL, 33136, USA.; The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA.
Jazyk: angličtina
Zdroj: European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society [Eur Spine J] 2024 Aug; Vol. 33 (8), pp. 3175-3190. Date of Electronic Publication: 2023 Dec 26.
DOI: 10.1007/s00586-023-08065-w
Abstrakt: Objective: Spondylodiscitis refers to infection of the intervertebral disk and neighboring structures. Outcomes based on instrumentation type are not well reported in the literature, but are important in establishing guidelines for surgical management of spondylodiscitis. This study aims to clarify the effect of instrumentation material selection on clinical and radiographic outcomes in patients with spondylodiscitis.
Methods: Studies that evaluated the use of polyetheretherketone (PEEK), titanium, allograft, and/or autologous bone grafts for spondylodiscitis were identified in the literature. Radiographic and clinical data were analyzed using a meta-analysis of proportions, with estimated risk and confidence intervals reported for our primary study outcomes.
Results: Thirty-two retrospective studies totaling 1088 patients undergoing surgical management of spondylodiscitis with PEEK, TTN, allograft, and autologous bone graft instrumentation were included. There were no differences in fusion rates (p-interaction = 0.55) with rates of fusion of 93.4% with TTN, 98.6% with allograft, 84.2% with autologous bone graft, and 93.9% with PEEK. There were no differences in screw loosening (p-interaction = 0.52) with rates of 0.33% with TTN, 0% with allograft, 1.3% with autologous bone graft, and 8.2% with PEEK. There were no differences in reoperation (p-interaction = 0.59) with rates of 2.64% with TTN, 0% with allograft, 1.69% with autologous bone graft, and 3.3% with PEEK.
Conclusions: This meta-analysis demonstrates that the choice of instrumentation type in the surgical management of spondylodiscitis resulted in no significant differences in rate of radiographic fusion, screw loosening, or reoperation. Future comparative studies to optimize guidelines for the management of spondylodiscitis are needed.
(© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE