Introduction: Over the past several decades, the incidence of spine fusion surgeries has increased significantly, driven by advancements in surgical techniques and an aging population. Demineralized bone matrix (DBM) is an allograft material that has become an increasingly popular adjunct in spinal fusion. However, limited comprehensive reviews exist, particularly focusing on DBM in spinal fusion over the past decade. This study aims to systematically review the literature on DBM in spinal fusion between 2014 and 2024 to assess its impact on fusion outcomes.
Methods: A systematic search was conducted in MEDLINE and CENTRAL databases, focusing on studies involving the clinical use of DBM in spinal fusion. Inclusion criteria were clinical studies with at least ten patients, reporting DBM products used, and fusion or pseudoarthrosis rates. Study design, sample size, type of procedure, complications, and outcomes were extracted, and risk of bias was assessed using the Cochrane Back and Neck criteria and the MINORS criteria.
Results: Twenty-two studies met inclusion criteria, including three randomized controlled trials (RCTs) and nineteen non-randomized studies. Most studies focused on DBM as an autograft extender. Fusion outcomes varied, with no significant differences between DBM and comparator treatments, though several studies reported non-inferior fusion rates for DBM. The quality of evidence was generally low due to nonrandomized designs and lack of control groups in most studies.
Conclusion : DBM appears to be a viable alternative to autograft in spinal fusion, particularly as an autograft extender. While fusion rates are comparable to other bone graft materials, the limited number of RCTs and low overall study quality call for further high-quality research, particularly in lumbar and posterior cervical spine fusion procedures.
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