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Comparative Study
. 2016 Jan 5:17:3.
doi: 10.1186/s12891-015-0861-2.

The fusion rate of demineralized bone matrix compared with autogenous iliac bone graft for long multi-segment posterolateral spinal fusion

Tsai-Sheng Fu  1 , I-Chun Wang  2 , Meng-Ling Lu  3 , Ming-Kai Hsieh  4 , Lih-Huei Chen  5 , Wen-Jer Chen  6
Affiliations
Comparative Study

The fusion rate of demineralized bone matrix compared with autogenous iliac bone graft for long multi-segment posterolateral spinal fusion

Tsai-Sheng Fu et al. BMC Musculoskelet Disord. .

Abstract

Background: Although autogenous iliac bone graft (AIBG) remains the gold standard for spine fusion, harvesting morbidity has prompted the search for alternatives especially for multi-segment fusion. This study aimed to evaluate the efficacy of using demineralized bone matrix (DBM) as a substitute of AIBG for long instrumented posterolateral fusion (≧ three-level fusion).

Methods: A total of 47 consecutive patients underwent laminectomy decompression, and multi-level instrumented posterolateral fusions were reviewed. Group 1 comprised 26 patients having DBM with autologous laminectomy bone (ALB). Group 2 consisted of 21 patients having AIBG with ALB. The fusion success evaluation was based on findings using the 12-month anteroposterior and dynamic plain radiographs.

Results: Gender, age, and the number of fusion levels were similar for both groups. 21 of 26 (80.8%) patients in group 1 and 18 of 21 (85.7%) patients in group 2 were observed to achieve solid bony fusion. There was no statistical difference in the fusion success (p = 0.72). Blood loss was significantly more in group 2 (p = 0.02). The duration of the hospital stays and operative times being longer for group 2, but the difference was not significant.

Conclusions: DBM combined with ALB and osteoconductive materials is as effective as an autologous iliac bone graft with respect to long multi-segment posterolateral fusion success. DBM can be used as an effective bone graft substitute and may decrease morbidities associated with iliac bone graft harvest.

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Figures

Fig. 1
Fig. 1
Radiographs from left to right showed the immediately, 3, 6, and 12 months postoperatively. The immediately postoperative image showed multiple opacity spots at the intertransverse space indicated a mixture of hydroxyapatite-β-tricalcium phosphate granules with laminectomy bone chips and DBM. The 12-month image showed a successful fusion mass with continuously qualitative bony bridging at the intertransverse fusion areas
Fig. 2
Fig. 2
Radiographs from left to right showed the immediately, 3, 6, and 12 months postoperatively. The immediately postoperative image showed bone graft materials (tricalcium phosphate granules, laminectomy bone chips and DBM) at the intertransverse space. The subsequent images showed absorption of the bone graft materials and unsuccessful fusion mass formation
Fig. 3
Fig. 3
A 80-year-old female underwent instrumentation and posterolateral fusion with DBM from L1 to L5 and received second operation for removal of implants. (Left) The postoperative 12-month image showed successful fusion mass formation with pedicle screws loosening. (Middle) The intraoperative image showed solid and continuous fusion mass formation. (Right) After removal of the implants, the plain radiographs showed continuous fusion mass formation from L1 to L5. f, fusion mass; p, pedicle screw hole; s, spinal process
See this image and copyright information in PMC

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