J Korean Soc Spine Surg.  2012 Dec;19(4):123-130. 10.4184/jkss.2012.19.4.123.

Comparison of Cage and Allograft Mixed Bone Marrow for Monosegmental Instrumented Posterior Lumbar Interbody Fusion

• Lim CH
• Kim DH
• Ahn SH
• Choi YS

• KMID: 2209546
• DOI: http://doi.org/10.4184/jkss.2012.19.4.123

Abstract

STUDY DESIGN: A retrospective study.
OBJECTIVES
To compare the radiological and clinical results between cage and cancellous allograft mixed with bone marrow for monosegmental instrumented posterior lumbar interbody fusion (PLIF). SUMMARY OF THE LITERATURE REVIEW: Allograft has potential problems, such as delayed union. Autologous bone marrow provides for improving the capability of bone induction with allograft. There are rare reports on PLIF using allograft mixed with autologous bone marrow.
MATERIALS AND METHODS
Monosegmental instrumented PLIF was performed on 51 patients who had lumbar degenerative disease, cage for 28 patients (cage group) and allograft mixed with bone marrow for 23 patients (allograft group). The clinical and radiological results in each group were compared.
RESULTS
The mean follow-up was 45 (30 - 111) months. At the final follow up, there was no significant difference between the cage group and the allograft group in the Korean Version Oswestry Disability Index (p=0.72) and Visual Analogue Score for back pain (p=0.54) and radiating pain to the leg (p=0.26). The radiological fusion rate was 92.8% in the cage group, and 82.6% in the allograft group (p=0.02). At the last follow up, disc height was decreased to 1.5+/-0.8 mm of the cage group, and 3.0+/-1.5 mm of the allograft group (p=0.0001).
CONCLUSIONS
PLIF using cancellous allograft mixed bone marrow has low fusion rate contrast to good clinical results. It is necessary to take a careful selection of the allograft mixed bone marrow for PLIF.

Keyword

Lumbar spine; Posterior lumbar interbody fusion; Cage; Cancellous allograft

MeSH Terms

Back Pain
Bone Marrow
Follow-Up Studies
Humans
Leg
Retrospective Studies
Transplantation, Homologous

Figure

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  Fig. 1. Case of cage group. A 63 year old female patient who had spon-dylolisthesis L4 on L5 was undergone posterior lumbar interbody fusion with cage and local bone.

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  Fig. 2. Case of allograft group. Photograph of the allograft and bone block (A), this bone block (arrow) that was harvested from facet joint could be provided not only mechanical stability of the disc space as a cage but also prevention from extrusion of mosellized graft. Postoperative lateral radiograph (B).

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  Fig. 3. The disc height was measured at the preoperative, postoperative and follow-up lateral radiograph.

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  Fig. 4. Revision for one case of allograft group. At 6-months follow-up, radiograph shows loss of disc height and absorption of the allograft (B). Histological finding reveals inflammation around dead allograft (C). After radical curettages, two cages filled with autograft were inserted (D) and at 40-months follow-up, computed tomographs show well bony fusion and loss of disc height (E).

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  Fig. 5. At 36 months follow-up, radiograph (A) and MRI (B) didn't achieved bony fusion of the allograft exactly. But at 54 months follow-up, radiograph revealed well bony fusion and maintenance of the disc height.

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