Meta-analysis of lumbar posterolateral fusion versus circumferential fusion in the treatment of the lumbar disease

Abstract

To evaluate the efficacy of lumbar posterolateral fusion versus circumferential fusion in the treatment of the lumbar disease. Searched MEDLINE (January, 1966 to December, 2007), EMBASE (January, 1984 to December, 2007), Cochrane Central Register of Controlled Trial (4th Quarter 2007), The China Biological Medicine Database (1984 to December, 2007), and hand searched several related journals, such as Spine, European Spine Journal, The Journal of Bone and Joint Surgery, Chinese Journal of Surgery, Chinese Journal of Orthopaedics, Chinese Journal of Spine and Spinal Cord, and so on. Searched the reviews, the clinical results and some other related studies on the two fusion techniques, and the quality of included trials was evaluated. Data were extracted by two reviewers independently with a designed extraction form. RevMan 5.0.5.0 software was used for data analysis of the fusion rate, the complication rate, the re-operation rate, the operative blood loss, the clinical outcome, and the operation time. Four randomized clinical trials (RCTs) involving 437 patients were included. The results of Meta-analysis indicated that in the fusion rate [OR 0.47, 95%CI (0.24, 0.94), P = 0.030], the complication rate [OR 0.53, 95%CI (0.32, 0.87), P = 0.010], and the operative blood loss [weighted mean difference (WMD) = -349.95, 95%CI (-561.64, -138.26), P = 0.001], the circumferential fusion group was significantly higher than the posterolateral fusion group. And in the re-operation rate [OR 2.28, 95%CI (1.30, 3.98), P = 0.004] the posterolateral fusion group was significantly higher than the circumferential fusion group. There were no statistically significant differences in the clinical outcome [OR 1.04, 95%CI (0.64, 1.68), P = 0.870] and the operation time [WMD = -90.24, 95%CI (-190.20, 9.71), P = 0.080]. To compare with the posterolateral fusion, the circumferential fusion can increase the fusion rate and reduce the re-operation rate, but it can also increase the complication rate and the blood loss. More high quality large-scale randomized controlled trials are required.