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Chin G, Lee YP, Lee J, Zhang N, Oh M, Rosen C, Bhatia N. Does conflict of interest affect the reported fusion rates of bone graft substitutes and extenders? NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2022; 10:100112. [PMID: 35330662 PMCID: PMC8938602 DOI: 10.1016/j.xnsj.2022.100112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/08/2022] [Accepted: 03/08/2022] [Indexed: 11/16/2022]
Abstract
Background Bone graft extenders are being used more in spine surgery as a substitute for iliac crest bone graft. However, potential conflict of interest could impact average fusion rates. The purpose of this study was to evaluate whether fusion rates reported in the literature were different in papers evaluating bone graft substitutes and extenders when there was potential conflict of interest versus no potential conflict of interest. Methods Pubmed was searched for studies evaluating fusion rates when bone graft extenders including demineralized bone matrix, hydroxyapatite, and tricalcium sulfate were used. Studies were screened for one or two level fusions and for degenerative spinal conditions. The average fusion rates of subgroups were compared using unpaired Student's t-tests. Results 1928 studies were evaluated. 86 studies were included in the study. The fusion rates varied from 4 to 100%. There were 24 studies with a potential conflict of interest and 62 studies with no conflict of interest. The average fusion rate of all the studies was 84.63% with standard deviation of 18.33%. The average fusion rates of those studies with conflict of interest was 80.93% versus 86.06% without conflict of interest. This was not statistically significant (p>0.07). The average fusion rate of studies evaluated by CT scan was 79.8% versus 87.9% without CT. The average fusion rate of studies that employed an independent reviewer to evaluate the fusion was 82.61% versus 85.63% for studies with no independent reviewer. Conclusion There is a great variability in the reported fusion rates of bone graft extenders. Counter to expectations, average fusion rates were lower in the studies where there was a potential conflict of interest. The use of CT scans and an independent reviewer seem to account for the lower reported fusion rates, and may be a means of negating the potential conflicts of interest in fusion studies. Level of Evidence 2
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Affiliation(s)
- Garwin Chin
- Department of Orthopaedic Surgery. Resident Physician of Orthopaedic Surgery, UC Irvine Medical Center, 101 The City Drive S, Pavilion 3, Building 29A, Second Floor, United States
| | - Yu-Po Lee
- Department of Orthopaedic Surgery. Resident Physician of Orthopaedic Surgery, UC Irvine Medical Center, 101 The City Drive S, Pavilion 3, Building 29A, Second Floor, United States
- Corresponding author at: Dr. Yu-Po Lee, University of California, Irvine, Department of Orthopaedic Surgery, 101 The City Drive S Pavilion 3, Building 29A, Second Floor Orange, CA 92868, United States, Tel: (714) 456-7752, Fax: (714) 456-7547.
| | - Joshua Lee
- Department of Orthopaedic Surgery. Resident Physician of Orthopaedic Surgery, UC Irvine Medical Center, 101 The City Drive S, Pavilion 3, Building 29A, Second Floor, United States
| | - Noah Zhang
- Department of Orthopaedic Surgery. Resident Physician of Orthopaedic Surgery, UC Irvine Medical Center, 101 The City Drive S, Pavilion 3, Building 29A, Second Floor, United States
| | - Michael Oh
- Department of Neurosurgery. UC Irvine Medical Center, United States
| | - Charles Rosen
- Department of Orthopaedic Surgery. Resident Physician of Orthopaedic Surgery, UC Irvine Medical Center, 101 The City Drive S, Pavilion 3, Building 29A, Second Floor, United States
| | - Nitin Bhatia
- Department of Orthopaedic Surgery. Resident Physician of Orthopaedic Surgery, UC Irvine Medical Center, 101 The City Drive S, Pavilion 3, Building 29A, Second Floor, United States
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The influence of industry sponsorship and conflict of interest on results and conclusions of systematic reviews regarding treatment of knee osteoarthritis. OSTEOARTHRITIS AND CARTILAGE OPEN 2021; 3:100142. [DOI: 10.1016/j.ocarto.2021.100142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/31/2021] [Accepted: 02/04/2021] [Indexed: 11/23/2022] Open
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