Difference of Fusion Rate in Minimally Invasive Transforaminal Lumbar Interbody Fusion with Autobone and Hydroxyapatite according to Mixture Ratio and Amount of Bone Graft

Jae-Sung Yoo; Sang-Hyuk Min; Sung-Hyun Yoon; Jun-Yeul Lee

doi:10.4055/jkoa.2013.48.5.382

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Yoo, Min, Yoon, and Lee: Difference of Fusion Rate in Minimally Invasive Transforaminal Lumbar Interbody Fusion with Autobone and Hydroxyapatite according to Mixture Ratio and Amount of Bone Graft

Original Article

Journal of the Korean Orthopaedic Association 2013; 48(5): 382-390.

Published online: 25 October 2013

DOI: https://doi.org/10.4055/jkoa.2013.48.5.382

Difference of Fusion Rate in Minimally Invasive Transforaminal Lumbar Interbody Fusion with Autobone and Hydroxyapatite according to Mixture Ratio and Amount of Bone Graft

Jae-Sung Yoo, M.D., Sang-Hyuk Min, M.D., Sung-Hyun Yoon, M.D., Jun-Yeul Lee, M.D.

Department of Othopedic Surgery, Dankook University Medical College, Cheonan, Korea.

Correspondence to: Sang-Hyuk Min, M.D. Department of Orthopedic Surgery, Dankook University Medical College, 119 Dandae-ro, Dongnam-gu, Cheonan 330-714, Korea. TEL: +82-41-550-3950, FAX: +82-41-556-3238, osmin71@naver.com

Received 2 April 2013 Revised 2 August 2013 Accepted 18 August 2013

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The aim of this study is to analyze the fusion rate according to the mixture ratio and the amount of bone graft in minimally invasive transforaminal lumbar interbody fusion (MI-TLIF).

Materials and Methods

This study included 92 subjects who underwent MI-TLIF. Patients were classified into either group I, in which patients received transplantation with only autogenous bone, group II, in which patients received transplantation with hydroxyapatite mixed with autogenous bone by more than 50%, or group III, in which patients received transplantation with hydroxyapatite mixed with autogenous bone by less than 50%. For analysis of the correlation of amount of bone graft with fusion rate, patients were divided into group A, having less than 12 ml of bone graft, and group B, having more than 12 ml of bone graft. Visual analogue scale and Oswestry disability index were used for clinical assessment, and Burkus' classification method was used for evaluation of bone fusion.

Results

Fusion rates of groups I, II, and III according to the mixture ratio were 90.9%, 86.5%, and 86.2%, respectively. The fusion rate increased as the autobone ratio became higher; however, no significant difference was found (p=0.16). The fusion rates were 81.5% and 92.5% in group A and group B, respectively, which were classified according to the volume of bone graft, showing a significant increase in groups with bone graft volume more than 12 ml (p=0.03).

Conclusion

A significantly high fusion rate was observed when bone graft volume was more than 12 ml in MI-TLIF. More than 12 ml of bone graft volume is essential for achievement of a satisfactory fusion rate.

Keywords: transforaminal lumbar interbody fusion, minimally invasive surgery, bone graft, fusion rate, hydroxyapatite

Figures and Tables

Figure 1

(A) Autogenous local bone and hydroxyapatite (5 ml). (B) First, a cage was filled with autogeneous local bone, and interbody space was filled with the remaining mixture of autogenous local bone and hydroxyapatite.

Figure 2

Radiograph and computed tomography of a case of definitely solid fusion (Grade I). (A) No motion on flexion-extension radiographs. (B) Continuous bony incorporation within and around the cage and new bone formation adjacent to the cage.

Figure 3

Radiograph and computed tomography of a case that was probably not solid fusion (Grade III). (A) No motion on flexion-extension radiographs. (B) Non continuous bony incorporation within and around the cage and new bone formation adjacent to the cage.

Table 1

Demographic Characteristics

M, male; F, female; BMD, bone matrix density; BMI, body mass index.

Table 2

Grades for Assessment of Fusion Status

Table 3

Clinical Results according to Mixture Ratio and Volumes

VAS, visual analogue scale; ODI, Oswetry disability index.

Table 4

Radiographic Fusion Status among Three Subgroups (I, II, III) (Mixture Ratio)

Table 5

Radiographic Fusion status between Two Groups (A, B) (Volumes)

Table 6

Clinical Results according to Union

VAS, visual analogue scale; ODI, Oswetry disability index.

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