Comment on “Combined use of tranexamic acid and rivaroxaban in posterior lumbar interbody fusion safely reduces blood loss and transfusion rates without increasing the risk of thrombosis-a prospective, stratified, randomized, controlled trial”

Abstract Study design: Prospective randomized controlled trial.Background: The CaO-SiO2-P2O5-B2O3 glass-ceramic (BGS-7) spacer is a recently developed spacer that shows chemical bonding to bone with high mechanical stability. Further, this spacer achieves similar results to those of titanium cages. However, evidence regarding the advantages of the BGS-7 spacer is weak compared to polyetheretherketone (PEEK) cage. A randomized controlled trial is therefore warranted. The purpose of this study was to compare the radiographic and clinical efficacies and safety of the BGS-7 spacer compared to those of the PEEK cage in patients who underwent posterior lumbar interbody fusion (PLIF). Methods: The 54 participants who required one- or two-level PLIF due to lumbar degenerative disorders were randomly assigned to receive a BGS-7 spacer or PEEK cage. Visual analog scale (VAS), Oswestry Disability Index (ODI), European Quality of Life-5 Dimensions (EQ-5D), painDETECT score were evaluated before surgery and at 3, 6, and 12 months after surgery. The fusion rate, degree of osteolysis, cage migration and subsidence around the cage (spacer) were evaluated on computer tomography (CT) images at 12 months after surgery. Results: The 12-month fusion rates were 75% in the BGS-7 spacer group and 79.3% in the PEEK cage group, with no significant difference (p=0.676). The result regarding the non-inferiority of BGS-7 spacer was inconclusive. The linear mixed model showed no significant intervention effect in VAS, ODI, EQ-5D, and painDETECT score at the 3-, 6-, or 12-month follow-up. In addition, we found no significant between-group differences in the extent of osteolysis, spacer migration. However, the subsidence around the cage was significantly lower in the BGS-7 spacer group. Conclusions: This trial found similar fusion rates, clinicoradiographic outcomes, and adverse events between the BGS-7 spacer and PEEK cage for PLIF. However, the non-inferiority was inconclusive, and thus, the BGS-7 spacer can be a feasible and safe alternative to PEEK cage in PLIF surgery after further studies.

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Trabecular metal spacers as standalone or with pedicle screw augmentation, in posterior lumbar interbody fusion: a prospective, randomized controlled trial

European Spine Journal ◽

10.1007/s00586-015-4229-y ◽

2015 ◽

Vol 24 (11) ◽

pp. 2597-2606 ◽

Cited By ~ 8

Author(s):

Erik Van de Kelft ◽

Johan Van Goethem

Keyword(s):

Randomized Controlled Trial ◽

Pedicle Screw ◽

Interbody Fusion ◽

Controlled Trial ◽

Posterior Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Trabecular Metal ◽

Randomized Controlled ◽

Screw Augmentation ◽

Prospective Randomized Controlled Trial

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Posterolateral Fusion Versus Posterior Lumbar Interbody Fusion: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Global Spine Journal ◽

10.1177/21925682211016426 ◽

2021 ◽

pp. 219256822110164

Author(s):

Elsayed Said ◽

Mohamed E. Abdel-Wanis ◽

Mohamed Ameen ◽

Ali A. Sayed ◽

Khaled H. Mosallam ◽

...

Keyword(s):

Systematic Review ◽

Blood Loss ◽

Interbody Fusion ◽

Revision Rate ◽

Meta Analysis ◽

Posterior Lumbar Interbody Fusion ◽

Operation Time ◽

Controlled Trials ◽

Lumbar Interbody Fusion ◽

Randomized Controlled

Study Design: Systematic review and meta-analysis. Objectives: Arthrodesis has been a valid treatment option for spinal diseases, including spondylolisthesis and lumbar spinal stenosis. Posterolateral and posterior lumbar interbody fusion are amongst the most used fusion techniques. Previous reports comparing both methods have been contradictory. Thus, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to establish substantial evidence on which fusion method would achieve better outcomes. Methods: Major databases including PubMed, Embase, Web of Science and CENTRAL were searched to identify studies comparing outcomes of interest between posterolateral fusion (PLF) and posterior lumbar interbody fusion (PLIF). We extracted data on clinical outcome, complication rate, revision rate, fusion rate, operation time, and blood loss. We calculated the mean differences (MDs) for continuous data with 95% confidence intervals (CIs) for each outcome and the odds ratio with 95% confidence intervals (CIs) for binary outcomes. P < 0.05 was considered significant. Results: We retrieved 8 studies meeting our inclusion criteria, with a total of 616 patients (308 PLF, 308 PLIF). The results of our analysis revealed that patients who underwent PLIF had significantly higher fusion rates. No statistically significant difference was identified in terms of clinical outcomes, complication rates, revision rates, operation time or blood loss. Conclusions: This systematic review and meta-analysis provide a comparison between PLF and PLIF based on RCTs. Although PLIF had higher fusion rates, both fusion methods achieve similar clinical outcomes with equal complication rate, revision rate, operation time and blood loss at 1-year minimum follow-up.

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