J Korean Soc Spine Surg.  2001 Mar;8(1):53-61.

Calcium Sulfate as a Graft Substitute for Spinal Fusion

• Ha KY
• Park SJ
• Choi WS
• Rho SH

Abstract

STUDY DESIGN: This is a prospective study to determine whether calcium sulfate(CS) used as a bone graft expander could promote spinal fusion as effectively as autogenous bone graft.
OBJECTIVES
To investigate the ability of CS to serve as bone graft substitute when combined in a 1:1 ratio with autogenous graft bone(AGB). SUMMARY OF LITERATURE REVIEW: Autogenous bone is considered the most successful bone graft material and is presently gold standard. Many complications, however, have been reported. Thus, numerous biodegradable osteoconductive ceramic bone graft substitute have received attention as alternative to autogenous bone to reduce the complications. The advantage of a biodegradable graft material is its compatibility with the new bone remodeling process required to attain optimum mechanical strength.
MATERIALS AND METHODS
Fifteen patients who had undergone posterolateral spinal fusion with instrumentation using CS mixed with AGB were evaluated. The patients received the autogenous iliac crest graft on one side of the spine and an equivalent volume of autogenous iliac crest/ CS combination on the other side. Thus, the patients serve as their own control. The number of segments fused was 45 segments. The implanted sites were assessed for new bone formation and bony fusion by plain radiography and CT.
RESULTS
Of 47 segments fused with CS and AGB, 42 segments (89.4%) were completely fused. In contrast, segments fused with AGB alone, 44 segments (93.6%) were fused. One patient showed nonunion at the both side. Two patients had nonunion at the fused segments with CS and ABG. However, the other side showed complete union. 5 patients who underwent removal of hardware had grossly and histologically complete union. There were no complications related to CS.
CONCLUSION
Calcium sulfate appeared to have some potential as a bone graft expender rather than a graft substitute when combined 1:1 ratio with ABG, despite fusion rate by CS mixed with AGB ws lower than AGB alone.

Keyword

Fusion; Osteoconduction; Calcium sulafte; Graft substitute

MeSH Terms

Bone Regeneration
Bone Remodeling
Calcium Sulfate*
Calcium*
Ceramics
Humans
Osteogenesis
Prospective Studies
Radiography
Spinal Fusion*
Spine
Transplants*
Calcium
Calcium Sulfate
Ceramics

Figure

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  Fig. 1-A. Postoperative roentgenogram Fig. 1-B. Postoperative 2 years. Complete union was noted in both graft sites. Fig. 1-C. On CT finding, there was bone formation on both transverse processes.

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  Fig. 2-A. Postoperative roentgenogram Fig. 2-B. Postoeprative 28 months. Calcium sulfate site was completely resorbed and showed nonunion. Fig. 2-C,D. No bony union in CS mixed with autogenous bone graft site, but were showing bony union on autogenous bone graft site.

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  Fig. 3. Showing multiple pores in CS mixed with AGB site(Rt) as compared with autogenous graft(Lt) on gross findings.

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  Fig. 4. Showing bony trabeculae. But osteocytes were not visible. There was no histologic difference between both groups in matrix (× 100, H-E staining). A: AGB site, B: CS mixed with AGB site

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