Osteoconductive Bone Graft Extenders in Posterolateral Thoracolumbar Spinal Fusion
Bibliographic record
Abstract
STUDY DESIGN: A systematic review. OBJECTIVE: To evaluate the efficacy, safety, and outcomes of osteoconductive bone graft extenders (BGEs) compared with iliac crest bone graft (ICBG) in posterolateral thoracolumbar spinal fusion. SUMMARY OF BACKGROUND DATA: ICBG is the current "gold standard" for achieving spinal arthrodesis. However, morbidity associated with its harvesting has led to the increased use of BGEs. METHODS: An electronic literature search was conducted through April 2011 using MEDLINE, EMBASE, CENTRAL, and Cochrane Library. Risk of bias and methodological assessment was performed using the Cochrane Risk of Bias Tool. Higgins I(2) test was used to assess for heterogeneity. Pooled weighted relative risk (RR) ratios were calculated to compare fusion and adverse event rates. Weighted standardized mean differences were calculated to compare functional outcome and pain scores. RESULTS: Thirteen studies were included representing a total of 768 patients. Overall study quality was low (mean Cochrane Risk of Bias score, 4.8 out of 12; range, 3-6). Fusion rates were comparable between the BGE and ICBG groups (RR, 0.96; 95% confidence interval [CI], 0.89-1.03; P = 0.28). Higgins I(2) test (58%) suggested substantial heterogeneity in the pooling of studies. The pooled rate of donor site pain in the ICBG group was 11.2% (95% CI, 7.4%-15.1%). Reported adverse events, excluding donor site pain, were significantly lower in the BGE group (RR, 0.42; 95% CI, 0.28-0.64; P < 0.0001). Functional outcomes were not significantly different between the 2 groups. CONCLUSION: Osteoconductive BGEs combined with local spine autograft and/or bone marrow aspirate have comparable fusion rates, similar functional outcomes, lower complication rates, and a lower risk of donor site pain than ICBG. Caution should be taken in interpreting these findings, given the low quality of the studies and the heterogeneity in the results. Randomized controlled studies using blinded assessments are required to help elucidate more conclusive evidence.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.025 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.010 | 0.008 |
| Bibliometrics | 0.005 | 0.005 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".