{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T07:59:04Z","timestamp":1789199944466,"version":"build-2803163510"},"reference-count":67,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2024,6,7]],"date-time":"2024-06-07T00:00:00Z","timestamp":1717718400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>We performed a meta-analysis to identify risk factors affecting spinal fusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We systematically searched PubMed, Embase, and the Cochrane Library from inception to January 6, 2023, for articles that report risk factors affecting spinal fusion. The pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using fixed-effects models for each factor for which the interstudy heterogeneity I\n                      <jats:sup>2<\/jats:sup>\n                      was &lt; 50%, while random-effects models were used when the interstudy heterogeneity I\n                      <jats:sup>2<\/jats:sup>\n                      was \u2265 50%. Using sample size, Egger\u2019s P value, and heterogeneity across studies as criteria, we categorized the quality of evidence from observational studies as high-quality (Class I), moderate-quality (Class II or III), or low-quality (Class IV). Furthermore, the trim-and-fill procedure and leave-one-out protocol were conducted to investigate potential sources of heterogeneity and verify result stability.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 1,257 citations screened, 39 unique cohort studies comprising 7,145 patients were included in the data synthesis. High-quality (Class I) evidence showed that patients with a smoking habit (OR, 1.57; 95% CI, 1.11 to 2.21) and without the use of bone morphogenetic protein-2 (BMP-2) (OR, 4.42; 95% CI, 3.33 to 5.86) were at higher risk for fusion failure. Moderate-quality (Class II or III) evidence showed that fusion failure was significantly associated with vitamin D deficiency (OR, 2.46; 95% CI, 1.24 to 4.90), diabetes (OR, 3.42; 95% CI, 1.59 to 7.36), allograft (OR, 1.82; 95% CI, 1.11 to 2.96), conventional pedicle screw (CPS) fixation (OR, 4.77; 95% CI, 2.23 to 10.20) and posterolateral fusion (OR, 3.63; 95% CI, 1.25 to 10.49).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Conspicuous risk factors affecting spinal fusion include three patient-related risk factors (smoking, vitamin D deficiency, and diabetes) and four surgery-related risk factors (without the use of BMP-2, allograft, CPS fixation, and posterolateral fusion). These findings may help clinicians strengthen awareness for early intervention in patients at high risk of developing fusion failure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0304473","type":"journal-article","created":{"date-parts":[[2024,6,7]],"date-time":"2024-06-07T13:55:15Z","timestamp":1717768515000},"page":"e0304473","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":13,"title":["Risk factors affecting spinal fusion: A meta-analysis of 39 cohort studies"],"prefix":"10.1371","volume":"19","author":[{"given":"Shudong","family":"Yang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beijun","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaxuan","family":"Mo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruidi","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunbo","family":"Mei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhi","family":"Zeng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaigai","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuwei","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0693-8695","authenticated-orcid":true,"given":"Mingjiang","family":"Luo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siliang","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhihong","family":"Xiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,6,7]]},"reference":[{"issue":"2","key":"pone.0304473.ref001","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.berh.2012.03.006","article-title":"Advancements in the management of spine disorders","volume":"26","author":"S Haldeman","year":"2012","journal-title":"Best Pract Res Clin Rheumatol"},{"issue":"1","key":"pone.0304473.ref002","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1186\/s13018-021-02444-z","article-title":"Postoperative bisphosphonate do not significantly alter the fusion rate after lumbar spinal fusion: a meta-analysis","volume":"16","author":"J Mei","year":"2021","journal-title":"J Orthop Surg Res"},{"issue":"8","key":"pone.0304473.ref003","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1177\/2192568218770769","article-title":"Degenerative Lumbar Spine Disease: Estimating Global Incidence and Worldwide Volume","volume":"8","author":"VM Ravindra","year":"2018","journal-title":"Global Spine J"},{"issue":"1","key":"pone.0304473.ref004","doi-asserted-by":"crossref","first-page":"7546","DOI":"10.1038\/s41598-022-11551-8","article-title":"A systematic review and meta-analysis of fusion rate enhancements and bone graft options for spine surgery","volume":"12","author":"WM Tavares","year":"2022","journal-title":"Sci Rep"},{"issue":"12","key":"pone.0304473.ref005","doi-asserted-by":"crossref","first-page":"1441","DOI":"10.1097\/01.brs.0000166503.37969.8a","article-title":"United States trends in lumbar fusion surgery for degenerative conditions","volume":"30","author":"RA Deyo","year":"2005","journal-title":"Spine (Phila Pa 1976)"},{"issue":"24 Suppl","key":"pone.0304473.ref006","first-page":"78s","article-title":"Lumbar spinal fusion. 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