J Korean Orthop Assoc.  2020 Apr;55(2):169-177. 10.4055/jkoa.2020.55.2.169.

Comparison of the Bone Union Rates Using a Local Autobone and Bone Graft Substitute Mixed Graft in Lumbar Posterolateral Fusion

Affiliations
  • 1Department of Orthopedic Surgery, Busan Medical Center, Busan, Korea
  • 2Department of Orthopedic Surgery, Kang-Il Hospital, Gimhae, Korea

Abstract

Purpose
To assess the effectiveness of mixed grafts in lumbar posterolateral fusion (PLF) by comparing the bone union rates of an autobone with a bone substitute mixed graft.
Materials and Methods
The patients were followed-up for at least two years after PLF and divided into four groups according to the mixed graft retrospectively. Group I was 48 cases using a femoral head allobone. Group II was 38 cases using b-tricalcium phosphate. Group III was 92 cases using biphasic calcium phosphate. Group IV was 38 cases using biphasic calcium phosphate and autologous bone marrow. Union was evaluated by the work up simple radiographs after two years from PLF. Union was defined if the radiographs demonstrated a bilateral continuity in the fusion mass between the cephalad and caudal transverse processes with less than 2° of angular motion and no translation between the vertebrae at the level of fusion on the lateral flexion-extension radiographs.
Results
According to simple radiographs after two years from PLF, the rate of union was highest in Group IV using local autobone, biphasic calcium phosphate and autologous bone marrow mixed graft.
Conclusion
Biphasic calcium phosphate is an osteoconductive bone substitute that increases the bio-absorbability and mechanical strength. Autologous bone marrow has osteoinductive and osteogenic properties. These features can increase the rate of bone union. Therefore, a local autobone, biphasic calcium phosphate and autologous bone marrow mixed graft can be considered an effective bone graft substitute for lumbar PLF instead of an autobone graft.

Keyword

posterolateral fusion; autografts; bone substitutes; mixed graft; union rate
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