Journal of Spine Practice
ISSN: 2789-9462
Leading research in all spine subspecialties focusing on orthopaedic spine, neurosurgery, radiology, and pain management.
Comparative Efficacy of Bone Graft Materials in Transforaminal Lumbar Interbody Fusion: A Systematic Review and Meta-Analysis
Published date: Jul 31 2025
Journal Title: Journal of Spine Practice
Issue title: Journal of Spine Practice (JSP): Volume 4, Issue 3
Pages: 88 - 103
Authors:
Abstract:
Introduction
Transforaminal lumbar interbody fusion (TLIF) is a widely used surgical technique for treating several spinal pathologies. While various bone graft materials (autograft, allograft, demineralized bone matrix) and cage materials (PEEK, titanium) are utilized in TLIF surgeries, there is a need to compare their effectiveness and safety to guide optimal material selection.
Aim
This study aims to compare the efficacy and safety of different bone graft materials used in TLIF surgeries by analyzing fusion rates, clinical outcomes, and complication rates across various studies.
Methods
A systematic search was conducted on PubMed and Google Scholar for studies related to TLIF and bone graft materials up to December 2023. Inclusion criteria were randomized controlled trials (RCTs) and prospective and retrospective cohort studies that reported quantitative outcomes like fusion rates and clinical improvement with a minimum post-operative follow-up of one year. Data from 11 studies were extracted and analyzed.
Results
This review included 11 studies with a total of 986 observations and 878 fusion events. The overall fusion rate was 87% (95% CI: 79%-94%), with significant heterogeneity among studies (I² = 92%). Autografts showed the highest fusion rate at 94% (95% CI: 90%-98%), with no heterogeneity (I² = 0%). Polyetheretherketone (PEEK) cages demonstrated a fusion rate of 90% (95% CI: 83%-97%), with moderate heterogeneity (I² = 80.6%). Allografts had a fusion rate of 76% (95% CI: 54%-98%), with high heterogeneity (I² = 86.7%). Titanium cages had a fusion rate of 87% (95% CI: 75%-99%), with moderate heterogeneity (I² = 79.9%). Visual Analogue Scale (VAS) scores for back pain in Heinz et al. (2017) decreased from 7.47 to 3.08 in Group A and from 6.78 to 3.17 in Group B at 12 months post-op. The overall Oswestry Disability Index (ODI) scores improved from pre-operative values of 53.0 to post-operative values of 22.3 in Li et al. (2020).
Conclusions
Autografts remain the gold standard for TLIF due to their high fusion rates, but synthetic materials like PEEK and titanium are effective alternatives with comparable fusion success and fewer complications related to graft harvesting. Continued research and innovation in developing new graft materials could enhance treatment outcomes in spinal surgery.
Keywords: allografts, autografts, bone grafts, lumbar vertebrae, spinal fusion
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