J Korean Neurosurg Soc.  2011 May;49(5):267-272. 10.3340/jkns.2011.49.5.267.

Radiographic Analysis of Instrumented Posterolateral Fusion Mass Using Mixture of Local Autologous Bone and b-TCP (PolyBone(R)) in a Lumbar Spinal Fusion Surgery

Affiliations
  • 1Department of Neurosurgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea. swroh@amc.seoul.kr
  • 2Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.

Abstract


OBJECTIVE
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(R) (Kyungwon Medical, Korea), a beta-tricalcium phosphate, for lumbar posterolateral fusion and assesses clinical and radiological efficacy as a graft material.
METHODS
This study retrospectively analyzed data from 32 patients (11 men, 21 women) who underwent posterolateral fusion (PLF) using PolyBone(R) 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.
RESULTS
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.
CONCLUSION
The present results indicate that the use of a mixture of local autologous bone and PolyBone(R) 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.

Keyword

Postero-Lateral fusion; PolyBone(R); Radiodensity

MeSH Terms

Back Pain
Calcium Phosphates
Durapatite
Follow-Up Studies
Humans
Imidazoles
Leg
Male
Nitro Compounds
Retrospective Studies
Spinal Fusion
Tissue Donors
Transplants
Calcium Phosphates
Durapatite
Imidazoles
Nitro Compounds
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