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Is dental prophylaxis required following spinal fusion?-a systematic review and call for evidence.

ABSTRACT: Background:Controversy exists regarding the need for antimicrobial prophylaxis prior to dental procedures following spinal fusion. In this review, we attempt to synthesize a comprehensive summary of the published literature to provide recommendations on the use of antimicrobial prophylaxis before dental procedures in patients with a history of spinal fusion. Methods:We searched PubMed, Web of Science, Cochrane Library, and EMBASE databases from inception to February 2018. Eligible studies included patients with a history of spinal fusion treated with or without antimicrobial prophylaxis in preparation for dental procedures. Two reviewers independently assessed the eligibility of potential studies and extracted data. Outcomes of interest were the indications and efficacy of antimicrobial prophylaxis to protect against infection of spinal prostheses with dental origin. Results:A total of 1,909 articles were initially screened. After inclusion and exclusion criteria were applied, one study was found specifically relating to dental prophylaxis and spine surgery. The survey, as well as objective studies and professional organization guidelines on dental prophylaxis in patients with total hip and knee replacements, were reviewed to add context to the controversy. Conclusions:There is a significant paucity of literature regarding dental prophylaxis in spine surgery patients. Although there has been a recent movement away from recommending antimicrobial prophylaxis before dental work in patients with other forms of orthopaedic prostheses, the gap in the literature addressing spine patients represents an important question that requires more targeted and specific research.

SUBMITTER: Martin P

PROVIDER: S-EPMC7154372 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Is dental prophylaxis required following spinal fusion?-a systematic review and call for evidence.

Martin Parker P Hundal Rajbir R Matulich Kathryn K Porta Maria M Patel Rakesh R Aleem Ilyas I

Journal of spine surgery (Hong Kong) 20200301 1

<h4>Background</h4>Controversy exists regarding the need for antimicrobial prophylaxis prior to dental procedures following spinal fusion. In this review, we attempt to synthesize a comprehensive summary of the published literature to provide recommendations on the use of antimicrobial prophylaxis before dental procedures in patients with a history of spinal fusion.<h4>Methods</h4>We searched PubMed, Web of Science, Cochrane Library, and EMBASE databases from inception to February 2018. Eligible ...[more]

PMID: 32309641

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Project description:Study designSystematic review.ObjectiveTo compare the effectiveness and safety between iliac crest bone graft (ICBG), non-ICBG autologous bone, and allograft in cervical spine fusion. To avoid problems at the donor site, various allograft materials have been used as a substitute for autograft. However, there are still questions as to the comparative effectiveness and safety of cadaver allograft compared with autologous ICBG.MethodsA systematic search of multiple major medical reference databases was conducted to identify studies evaluating spinal fusion in patients with cervical degenerative disk disease using ICBG compared with non-ICBG autograft or allograft or non-ICBG autograft compared with allograft in the cervical spine. Radiographic fusion, patient-reported outcomes, and functional outcomes were the primary outcomes of interest. Adverse events were evaluated for safety.ResultsThe search identified 13 comparative studies that met our inclusion criteria: 2 prospective cohort studies and 11 retrospective cohort studies. Twelve cohort studies compared allograft with ICBG autograft during anterior cervical fusion and demonstrated with a low evidence level of support that there are no differences in fusion percentages, pain scores, or functional results. There was insufficient evidence comparing patients receiving allograft with non-ICBG autograft for fusion, pain, revision, and functional and safety outcomes. No publications directly comparing non-ICBG autograft with ICBG were found.ConclusionAlthough the available literature suggests ICBG and allograft may have similar effectiveness in terms of fusion rates, pain scores, and functional outcomes following anterior cervical fusion, there are too many limitations in the available literature to draw any significant conclusions. No individual study provided greater than class III evidence, and when evaluating the overall body of literature, no conclusion had better than low evidence support. A prospective randomized trial with adequate sample size to compare fusion rates, efficacy measures, costs, and safety is warranted.

Project description:IntroductionInduction of an inflammatory response is thought to have a significant role in the complications that follow cardiopulmonary bypass (CPB). The statin drugs are increasingly being recognized as having potent anti-inflammatory effects and hence have potential to influence an important mechanism of injury in CPB, although there is no current confirmation that this is indeed the case. Our objective was to systematically review if pre-operative prophylactic statin therapy, compared with placebo or standard of care, can decrease the inflammatory response in people undergoing heart surgery with CPB.MethodsWe performed a systematic and comprehensive literature search for all randomized controlled trials (RCTs) of open heart surgery with CPB in adults or children who received prophylactic statin treatment prior to CPB, with reported outcomes which included markers of inflammation. Two authors independently identified eligible studies, extracted data, and assessed study quality using standardized instruments. Weighted mean difference (WMD) was the primary summary statistic with data pooled using a random effects model. Descriptive analysis was used when data could not be pooled.ResultsEight RCTs were included in the review, with the number of trials for each inflammatory outcome being even more limited. Pooled data demonstrated benefit with the use of statin to attenuate the post-CPB increase in interleukins 6 and 8 (IL-6, IL-8), peak high sensitivity C-reactive protein (hsCRP), and tumor necrosis factor-alpha (TNF-alpha) post-CPB (WMD [95% confidence interval (CI)] -23.5 pg/ml [-36.6 to -10.5]; -23.4 pg/ml [-35.8 to -11.0]; -15.3 mg/L [CI -26.9 to -3.7]; -2.10 pg/ml [-3.83 to -0.37] respectively). Very limited RCT evidence suggests that prophylactic statin therapy may also decrease adhesion molecules following CPB including neutrophil CD11b and soluble P (sP)-selectin.ConclusionsAlthough the RCT evidence may suggest a reduction in post-CPB inflammation by statin therapy, the evidence is not definitive due to significant limitations. Several of the trials were not methodologically rigorous and statin intervention was highly variable in this small number of studies. This systematic review demonstrates that there is a significant gap that exists in the current literature in regards to the potential anti-inflammatory effect of statin therapy prior to CPB.

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Is dental prophylaxis required following spinal fusion?-a systematic review and call for evidence.

Publications

Is dental prophylaxis required following spinal fusion?-a systematic review and call for evidence.

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