J Korean Soc Spine Surg.  2015 Jun;22(2):37-42. 10.4184/jkss.2015.22.2.37.

Union Rates of Autologous Bone Marrow, Local Autobone and Biphasic Calcium Phosphate Mixed Graft in Lumbar Posterolateral Fusion

• Park MJ
• Ko YC
• Eun IS
• Huh JW
• Hwang KM
• Park SH
• Park TH

• KMID: 2322950
• DOI: http://doi.org/10.4184/jkss.2015.22.2.37

Abstract

STUDY DESIGN: A retrospective study.
OBJECTIVES
We examined union rates and clinical outcomes to evaluate the efficacy of using autologous bone marrow along with a local autobone and biphasic calcium phosphate mixed graft with posterolateral fusion in spinal stenosis and spondylolisthesis. SUMMARY OF LITERATURE REVIEW: In lumbar posterolateral fusion, union rates of biphasic calcium phosphate and local autobone mixed graft are low compared to union rates of autogenous iliac bone graft.
MATERIALS AND METHODS
Among the patients who had lumbar posterolateral fusion with autologous bone marrow along with local autobone and biphasic calcium phosphate mixed graft between February 2013 and January 2014, we analyzed 40 patients who were available for at least one year of follow-up. There were 22 cases with spinal stenosis and 18 cases with spondylolisthesis. Bone fusion was determined along with the fusion rates based on Lenke's criteria (citation). All patients were evaluated postoperatively at one year, using 3D CT. and the clinical outcomes were assessed using Kim's method (citation).
RESULTS
In spinal stenosis, bone union was observed in 19 cases out of 22 (86.4%), and in case of spondylolisthesis, bone union was observed in 16 cases out of 18 (88.9%). In spinal stenosis, the clinical outcomes were: 2 excellent, 16 good, 3 fair, and 1 poor; in other words 18 cases (81.8%) displayed good or excellent outcomes. In spondylolisthesis, 2 excellent, 12 good, 4 fair and 0 poor; in other words, 14 cases (77.8%) showed good or superior outcomes.
CONCLUSIONS
Posterolateral fusion using autologous bone marrow along with a local autobone and biphasic calcium phosphate mixed graft showed similar bone fusion rates to using autogenous iliac bone graft. Therefore, this method could serve as an alternative to using autogenous iliac bone graft in posterior lumbar fusion.

Keyword

Spinal stenosis; Spondylolisthesis; Posterolateral fusion; Biphasic calcium phosphate; Autologous bone marrow

MeSH Terms

Bone Marrow*
Calcium*
Follow-Up Studies
Humans
Retrospective Studies
Spinal Stenosis
Spondylolisthesis
Transplants*
Calcium

Figure

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  Fig. 1. (A) A 72-year-old female's preoperative simple radiograph. (B) At 12-months postoperatively, the radiograph shows complete bony union of Lenke A degree. (C) At 12-months postoperatively, 3D CT shows sufficient bone mass.

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  Fig. 2. (A) A 57-year-old male's preoperative simple radiograph. (B) At 12-months postoperatively, the radiograph shows complete bony union unilaterally of Lenke B degree. (C) At 12-months postoperatively, 3D CT shows right sufficient bone mass and left small bone mass.

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  Fig. 3. (A) A 70-year-old female's preoperative simple (radiograph?). (B) At 12-months postoperatively, the radiograph shows bony union of Lenke C degree. (C) At 12-months postoperative 3D CT shows insufficient bone mass.

Reference

1. Watkins MB. Posterolateral fusion of the lumbar and lumbosacral spine. J Bone Joint Surg Am. 1953; 35:1014–8.

2. Lee CK, Langrana NA. Lumbosacral spinal fusion. A biomechanical study. Spine (Phila Pa 1976). 1984; 9:574–81.

3. Rombold C. Treatment of spondylolisthesis by posterolateral fusion, resection of the pars interarticularis and prompt immobilization of the patients. J Bone Joint Surg Am. 1966; 48:1282–300.

4. Turner JA, Ersek M, Herron L, et al. Patient outcomes after lumbar spinal fusion. JAMA. 1992; 268:907–11.

5. Lee SU, Kim KT, Ahn OK, et al. Posterolateral fusion in spondylolisthesis. J of Korean Orthop. 1996; 31:695–701.

6. Younger EX, Chapman MW. Morbidity at bone graft donor sites. Orthop Trans. 1986; 10:494.

7. Thalgott JS, Fritts K, Giuffre JH, et al. Anterior interbody fusion of the cervical spine with coralline hydroxyapatite. Spine (Phila Pa 1976). 1999; 24:1295–9.

8. Thalgott JS, Fritts K, Giuffre JH, et al. The use of coralline hydroxyapatite for interbody spinal fusions. Spine State Art Reviews. 1997; 11:325–39.

9. Cosar M, Ozer AF, Iplikcioglu AC, et al. The results of beta-tricalcium phosphate coated hydroxyapatite (beta-TCP/HA) grafts for interbody fusion after anterior cervical discectomy. J Spinal Disord Tech. 2008; 21:436–41.

10. Yamada S, Heymann J, Bouler M, et al. Osteoclastic re-sorption of calcium phosphate ceramics with different hydroxyapatite/β-tricalcium phosphate ratios. Biomaterials. 1997; 18:1037–41.

11. Connolly JF, Guse R, Tiedeman J, et al. Autologous marrow injection as a substitute for operative grafting of tibial nonunions. Clin Orthop Relat Res. 1991; 266:259–70.

12. Seitz WH Jr., Froimson AI, Leb RB. Autogenous bone marrow and allograft replacement of bone defects in the hand and upper extremities. J Orthop Trauma. 1992; 6:36–42.

13. Lane JM, Yasko AW, Tomin E, et al. Bone marrow and recombinant human bone morphogenetic protein-2 in os-seous repair. Clin Orthop Relat Res. 1999; 361:216–27.

14. Vaccaro AR, Chiba K, Heller JG, et al. Bone grafting alternatives in spinal surgery. Spine J. 2002; 2:206–15.

15. Lenke LG, Bridgwell KH, Baldus C, et al. Contrel-Du-bousset instrument tation for adolescent idiopathic scoliosis. J Bone Joint surg Am. 1992; 74:1056–69.

16. Kim NH, Kim DJ. Anterior interbody fusion for spondulo-listhesis. Orthopedics. 1991; 14:1069–76.

17. Aaron AD, Wiedel JD. Allograft use in orthopedic surgery. Orthopedics. 1994; 17:41–8.

18. Ehrler DM, Vaccaro AR. The use of allograft bone in lumbar spine surgery. Clin Orthop Relat Res. 2000; 371:38–45.

19. Huh JW, Ko YC, Jung CY. Biphasic calcium phosphate and local autobone mixed graft in lumbar posterolateral fusion. J Korean Soc Spine Surg. 2014; 21:103–8.

20. Scoff HD. Bone marrow/allograft component therapy. A clinical trial. Am J Orthop (Belle Mead NJ). 1995; 24:40–7.

21. Wientroub S, Goodwin D, Khermosh O, et al. The clinical use of autologous marrow to improve osteogenic potential of bone grafts in pediatric orthopedics. J Pediatr Orthop. 1989; 9:186–90.

22. Cho SH, Kim DH, Jeong ST, et al. The effect of hydroxyapatite-tricalcium phosphate compound with mixed bone marrow as a bone graft substitute. J Kor Musculoskelet Transplant Soc. 2007; 7:57–64.

23. Scott HK, Michael YW, Carl LL. Techniques for aspirating bone marrow for use in spinal surgery. Neurosurgery. 2005; 57:286–9.

24. Ricciardi JE, Pflueger PC, Isaza JE, et al. Transpedicular fixation for the treatment of isthmic spondylolisthesis in adults. Spine (Phila Pa 1976). 1995; 20:1917–22.

25. Shin BJ, Min KD, Kwon H. Surgical results of isthmic spondylolisthesis – Comparison of posterolateral fusion vs PLIF. J Korean Soc Spine Surg. 1996; 3:61–8.

26. Yang JY, Lee JK, Kim DH, et al. The effect of β–tricalcium phosphate in lumbar posterolateral fusion surgery – A prospective study -. J Kor Musculoskelet Transplant Soc. 2006; 6:13–8.