J Korean Neurosurg Soc.  2016 Jul;59(4):363-367. 10.3340/jkns.2016.59.4.363.

Matched Comparison of Fusion Rates between Hydroxyapatite Demineralized Bone Matrix and Autograft in Lumbar Interbody Fusion

• Kim DH
• Lee N
• Shin DA
• Yi S
• Kim KN
• Ha Y

• KMID: 2315971
• DOI: http://doi.org/10.3340/jkns.2016.59.4.363

Abstract

OBJECTIVE
To compare the fusion rate of a hydroxyapatite demineralized bone matrix (DBM) with post-laminectomy acquired autograft in lumbar interbody fusion surgery and to evaluate the correlation between fusion rate and clinical outcome.
METHODS
From January 2013 to April 2014, 98 patients underwent lumbar interbody fusion surgery with hydroxyapatite DBM (HA-DBM group) in our institute. Of those patients, 65 received complete CT scans for 12 months postoperatively in order to evaluate fusion status. For comparison with autograft, we selected another 65 patients who underwent lumbar interbody fusion surgery with post-laminectomy acquired autograft (Autograft group) during the same period. Both fusion material groups were matched in terms of age, sex, body mass index (BMI), and bone mineral density (BMD). To evaluate the clinical outcomes, we analyzed the results of visual analogue scale (VAS), Oswestry Disability Index (ODI), and Short Form Health Survey (SF-36).
RESULTS
We reviewed the CT scans of 149 fusion levels in 130 patients (HA-DBM group, 75 levels/65 patients; Autograft group, 74 levels/65 patients). Age, sex, BMI, and BMD were not significantly different between the groups (p=0.528, p=0.848, p=0.527, and p=0.610, respectively). The HA-DBM group showed 39 of 75 fused levels (52%), and the Autograft group showed 46 of 74 fused levels (62.2%). This difference was not statistically significant (p=0.21). In the HA-DBM group, older age and low BMD were significantly associated with non-fusion (61.24 vs. 66.68, p=0.027; -1.63 vs. -2.29, p=0.015, respectively). VAS and ODI showed significant improvement after surgery when fusion was successfully achieved in both groups (p=0.004, p=0.002, HA-DBM group; p=0.012, p=0.03, Autograft group).
CONCLUSION
The fusion rates of the hydroxyapatite DBM and Autograft groups were not significantly different. In addition, clinical outcomes were similar between the groups. However, older age and low BMD are risk factors that might induce non-union after surgery with hydroxyapatite DBM.

Keyword

Hydroxyapatite; Autograft; Fusion; CT scan

MeSH Terms

Autografts*
Body Mass Index
Bone Density
Bone Matrix*
Durapatite*
Health Surveys
Humans
Risk Factors
Tomography, X-Ray Computed
Durapatite

Figure

• 

  Fig. 1 Fusion assessment using computed tomography (CT) scan. A : Fused, cortical continuity was observed without a visual gap on CT scan, white arrow. B : Not fused, cortical discontinuity was observed with a visual gap, black arrow.

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