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. 2015 Jun 25;6(Suppl 10):S318-22.
doi: 10.4103/2152-7806.159380. eCollection 2015.

Preliminary study showing safety/efficacy of nanoss bioactive versus vitoss as bone graft expanders for lumbar noninstrumented fusions

Nancy E Epstein  1
Affiliations

Preliminary study showing safety/efficacy of nanoss bioactive versus vitoss as bone graft expanders for lumbar noninstrumented fusions

Nancy E Epstein. Surg Neurol Int. .

Abstract

Background: The lateral fusion mass for multilevel lumbar laminectomies with noninstrumented posterolateral fusions now often utilizes lamina autograft and bone marrow aspirate (BMA) mixed with one of two bone graft expanders: either Vitoss (Orthovita, Malvern, PA, USA) or NanOss Bioactive (Regeneration Technologies Corporation: RTI, Alachua, FL, USA).

Methods: Here, we compared two sequential prospective the times to fusion, fusion rates, complications, and infection rates for two prospective cohorts of patients utilizing either Vitoss (first 213 patients) or NanOss (subsequent 45 patients) respectively, undergoing multilevel lumbar laminectomies (average 4.6 vs. 4.5 levels) with noninstrumented fusions (average 1.3 vs. 1.2 levels). Surgery addressed stenosis/ossification of the yellow ligament (OYL) (all patients), with subsets exhibiting degenerative spondylolisthesis synovial cysts, and disc disease. Fusion was documented by two independent neuroradiologists blinded to the study design, utilizing dynamic X-rays and two dimensional computed tomography (2D-CT) studies up to 6 months postoperatively, and up to 1 year where indicated.

Results: Comparison of patients receiving Vitoss versus NanOss as bone graft expanders revealed nearly comparable; times to fusion (5.3 months vs. 4.8 months), fusion rates (210 [98.6%] vs. 45 [100%] patients), pseudarthroses (3 [1.4%] vs. 0), postoperative seromas (2 [0.94%] vs. 0), and deep wound infections (2 [0.94%] vs. 0).

Conclusion: In this preliminary study of patients undergoing multilevel lumbar lamienctomies with posterolateral noninstrumented fusions, results were nearly comparable utilizing Vitoss or NanOss as bone graft expanders. Although the number of NanOss patients was substantially lower, the comparable efficacy and absence of postoperative complications for noninstrumented fusions is promising.

Keywords: Autograft; Beta-TriCalcium phosphate; NanOss Bioactive; Vitoss; noninstrumented lumbar fusion; pseudarthrosis rates.

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Figures

Figure 1
Figure 1
A 73-year-old female underwent a multilevel L2-S1 lumbar laminectomy and noninstrumented L4-5 posterolateral fusion (for grade I degenerative spondylolisthesis) utilizing lamina autograft/BMA/Vitoss. The 6-month postoperative axial CT study demonstrated continuity of the fusion mass consistent with adequate arthrodesis
Figure 2
Figure 2
For the same patient from Figure 1, the 6-month postoperative parasagittal 2D soft tissue CT scan demonstrated continuity of the lamina autograft/BMA/Vitoss over the L4-L5 transverse processes consistent with posterolateral noninstrumented arthrodesis
Figure 3
Figure 3
A 75-year-old female underwent a multilevel L1-S1 laminectomy and noninstrumented L4-L5 posterolateral fusion (for grade I degenerative spondylolisthesis) utilizing lamina autograft/BMA/NanOss. The 6-month postoperative axial CT study demonstrated similar continuity of the fusion mass consistent with arthrodesis
Figure 4
Figure 4
For the same patient from Figure 3, the 6-month postoperative parasagittal 2D bone window CT demonstrated continuity of the lamina autograft/BMA/NanOss over the L4-L5 posterolateral noninstrumented fusion mass consistent with arthrodesis
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References

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