Radiographic Analysis of Instrumented Posterolateral Fusion Mass Using Mixture of Local Autologous Bone and b-TCP (PolyBone®) in a Lumbar Spinal Fusion Surgery
Open Access
- 1 January 2011
- journal article
- Published by Korean Neurosurgical Society in Journal of Korean Neurosurgical Society
- Vol. 49 (5), 267-272
- https://doi.org/10.3340/jkns.2011.49.5.267
Abstract
Although iliac crest autograft is the gold standard for lumbar fusion, the morbidity of donor site leads us to find an alternatives to replace autologous bone graft. Ceramic-based synthetic bone grafts such as hydroxyapatite (HA) and b-tricalcium phosphate (b-TCP) provide scaffolds similar to those of autologous bone, are plentiful and inexpensive, and are not associated with donor morbidity. The present report describes the use of Polybone® (Kyungwon Medical, Korea), a beta-tricalcium phosphate, for lumbar posterolateral fusion and assesses clinical and radiological efficacy as a graft material. This study retrospectively analyzed data from 32 patients (11 men, 21 women) who underwent posterolateral fusion (PLF) using PolyBone® from January to August, 2008. Back and leg pain were assessed using a Numeric Rating Scale (NRS), and clinical outcome was assessed using the Oswestry Disability Index (ODI). Serial radiological X-ray follow up were done at 1, 3, 6 12 month. A computed tomography (CT) scan was done in 12 month. Radiological fusion was assessed using simple anterior-posterior (AP) X-rays and computed tomography (CT). The changes of radiodensity of fusion mass showed on the X-ray image were analyzed into 4 stages to assess PLF status. The mean NRS scores for leg pain and back pain decreased over 12 months postoperatively, from 8.0 to 1.0 and from 6.7 to 1.7, respectively. The mean ODI score also decreased from 60.5 to 17.7. X-rays and CT showed that 25 cases had stage IV fusion bridges at 12 months postoperatively (83.3% success). The radiodensity of fusion mass on X-ray AP image significantly changed at 1 and 6 months. The present results indicate that the use of a mixture of local autologous bone and PolyBone® results in fusion rates comparable to those using autologous bone and has the advantage of reduced morbidity. In addition, the graft radiodensity ratio significantly changed at postoperative 1 and 6 months, possibly reflecting the inflammatory response and stabilization.Keywords
This publication has 12 references indexed in Scilit:
- Two-year fusion and clinical outcomes in 224 patients treated with a single-level instrumented posterolateral fusion with iliac crest bone graftThe Spine Journal, 2009
- Local autogenous bone mixed with bone expander: an optimal option of bone graft in single-segment posterolateral lumbar fusionSurgical Neurology, 2008
- Contemporary alternatives to synthetic bone grafts for spine surgery.2008
- Calcium Phosphates as Bone Graft ExtendersOrthopedics, 2007
- Comparative performance of three ceramic bone graft substitutesThe Spine Journal, 2007
- Radiographic Analysis of Fusion Mass Using Fresh Autologous Bone Marrow With Ceramic Composites as an Alternative to Autologous Bone GraftJournal of Spinal Disorders & Techniques, 2007
- Critical Analysis of Trends in Fusion for Degenerative Disc Disease Over the Past 20 YearsSpine, 2004
- A Synthetic Porous Ceramic as a Bone Graft Substitute in the Surgical Management of ScoliosisSpine, 2000
- Alternatives to Autogenous Bone Graft: Efficacy and IndicationsJournal of the American Academy of Orthopaedic Surgeons, 1995
- Harvesting Autogenous Iliac Bone GraftsSpine, 1989