2023, Vol. 27 ›› Issue (9): 1434-1440

Meta-analysis of the efficacy and safety of 3D printed porous titanium alloy fusion cage in anterior cervical discectomy and fusion

Wang Yanjin1,2, Zhou Yingjie2, Chai Xubin2, Zhuo Hanjie2   

Abstract: OBJECTIVE: To systematically evaluate the clinical efficacy and safety of 3D printed cages in anterior cervical discectomy and fusion.
METHODS: PubMed, Embase, The Cochrane Library, CBM, CNKI, Wanfang, and VIP databases were searched to collect the clinical controlled trial articles on 3D printed fusion cage (3D Cage) placed in anterior cervical discectomy and fusion surgery from database establishment to April 2022. Two independent investigators performed literature screening, data extraction and quality evaluation according to the inclusion and exclusion criteria. Meta-analysis was performed on the outcome measures using RevMan 5.3 software.  
RESULTS: (1) A total of 11 relevant articles were included, containing 2 articles of randomized controlled trials with moderate risk of bias and 9 articles of high-quality retrospective study. A total of 691 patients were involved, 338 cases in the test group (3D cage implantation) and 353 cases in the control group (other implant implantation). (2) Meta-analysis results showed that there was no significant difference in the fusion rate (RR=1.03, 95%CI: 0.98 to 1.07, P=0.23) between the two groups. The operation time (MD=-11.84, 95%CI: -17.12 to -6.57, P < 0.000 1), intraoperative blood loss (MD=-10.60, 95%CI: -16.86 to -4.33, P=0.000 9), complications (RR=0.55, 95%CI: 0.35 to 0.88, P=0.01), C2-7 Cobb angle (MD=4.14, 95%CI: 3.42 to 4.85, P < 0.000 01), intervertebral space height (MD=0.48, 95%CI: 0.25 to 0.70, P < 0.000 01) and cervical JOA score under analysis (SMD=0.55, 95%CI: 0.29 to 0.82, P < 0.000 1; SMD = 1.09, 95%CI: 0.73 to 1.46, P < 0.000 01) were superior in the test group to those in the control group.
CONCLUSION: The fusion rate of 3D Cage was not inferior to other implants. 3D Cage could shorten operation time, reduce intraoperative blood loss and reduce the occurrence of complications; it could promote the sagittal balance of cervical vertebra and the recovery of neurological function.
Key words: 3D printing, titanium alloy, intervertebral fusion cage, cervical spondylosis, cervical discectomy, meta-analysis