Lumbar Posterolateral Fusion Using Demineralized Bone Matrix

Sang Wook Bae; Ho Yoon Kwak; Jae Yoon Kim; Joo Sun Jung

doi:10.4184/jkss.2007.14.4.256

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Bae, Kwak, Kim, and Jung: Lumbar Posterolateral Fusion Using Demineralized Bone Matrix

Original Article

Journal of Korean Spine Surg 2007;14(4):256-262.

Published online: 21 February 2007

DOI: https://doi.org/10.4184/jkss.2007.14.4.256

Lumbar Posterolateral Fusion Using Demineralized Bone Matrix

Sang Wook Bae, M.D., Ho Yoon Kwak, M.D., Jae Yoon Kim, M.D., Joo Sun Jung, M.D.

Department of Orthopedic Surgery, Eulji Hospital, Eulji University School of Medicine

Address reprint requests to Sang Wook Bae, M.D. Department of Orthopedic Surgery, Eulji Hospital, Eulji University 280-1, Hagye-1-dong, Nowon-ku, Seoul, Korea Tel: 82-2-970-8260, Fax: 82-2-972-0068, E-mail: bsw2402@eulji.ac.kr

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

Study Design

A retrospective study.

Objectives

To compare the efficacy of demineralized bone matrix as a bone graft extender in lumbar posterolateral fusion with cases using an autogenous iliac bone graft.

Summary of Literature Review

Since demineralized bone grafts were introduced for bone graft extension in 1995, many types of demineralized bone matrices have been used with improved fusion rates.

Materials and Methods

From October 2004 to December 2005, demineralized bone matrices were used as iliac bone graft extenders in 49 cases (Group I) of lumbar posterolateral fusion, compared with 50 cases receiving autogenous grafts (Group II) similar in age, bone marrow density, and number of fusion levels. Fusion status was graded by the Lenke classification and data was analyzed using a chi-square test through SPSS v.10.0.

Results

Group I had Lenke A in 7 cases (14.3%), B in 21 cases (42.9%), C in 15 cases (30.6%), and D in 6 cases (12.2%). Group II had Lenke A in 9 cases (18.0%), B in 26 cases (52.0%), C in 12 cases (24.0%), and D in 3 cases (6.0%). There was no statistical difference in fusion rate.

Conclusion

Demineralized bone matrix could be used as a bone graft extender in lumbar posterolateral fusion.

Keywords: Demineralized bone matrix, Posterolateral fusion

REFERENCES

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2). Lenke L, Bridwell K, Bullis D, Betz R, Baldus C, Schoenecker C. Results of in situ fusion for isthmic spondylolisthesis. J Spinal Disord. 1992; 5:433–443.

3). Sanden B, Orelud C, Petren-Malmin M, Johansson C, Larsson S. The significance of radiolucent zones surrounding pedicle screws. J Bone Joint Surg Br. 2004; 86:457–461.

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5). Urist MR. Bone formation by autoinduction. Science. 1965; 150:893–899.

6). Cammisa FP Jr, Lowery G, Garfin SR, et al. Two-year fusion rate equivalency between Grafton DBM gel and autograft in posterolateral spine fusion: a prospective controlled trial employing a side-by-side comparison in the same patient. Spine. 2004; 29:660–666.

7). Gigardi FP, Cammisa FP Jr. The effect of bone graft extenders to enhance the performance of iliac crest bone grafts in instrumented lumbar spinal fusion. Orthopedics. 2003; 26:545–548.

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10). Cook SD, Dalton JE, Prewett AB, Whitecloud TS 3rd. In vivo evaluation of demineralized bone matrix as a bone graft substitute for posterior spinal fusion. Spine. 1995; 20:877–886.

11). Helm GA, Sheehan JM, Sheehan JP, et al. Utilization of type I collagen gel, demineralized bone matrix, and bone morphogenetic protein-2 to enhance autologous bone lumbar spinal fusion. J Neurosurg. 1997; 86:93–100.

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13). Lidsey RW, Wood GW, Sadasivian KK, Stubbs HA, Block JE. Grafting long bone fractures with demineralized bone matrix putty enriched with bone matrix: pilot findings. Orthopedics. 2006; 29:939–941.

14). Qiu QQ, Shih MS, Stock K, et al. Evaluation of DBM/AM composite as a graft substitute for posterolateral lumbar fusion. J Biomed Mater Res B Appl Biomater 2006;Dec 20: Epub ahead of print.

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Figures and Tables%

Fig. 1.

(A) Postoperative x-ray of 82-year-old female patient who is grafted using Grafton demineralized bone matrix. (B) Bilateral thick and solid fusion masses are seen in posteoperative 1 year and classified as Lenke A.

Fig. 2.

(A) 62-year-old male patient's postoperative X-ray shows that Orthoblast II was used with laminar fragmented bone which was removed during decompression. (B) Grafted demineralized bone matrix and autogenous laminar bone are disappeared and radiolucent zone surrounding pedicle screws are seen. Lenke classification D.

Table 1.

Patients using demineralized bone matrix

No	Age	Sex	BMD T-score	Diagnosis	Level of fusion	Type of DBM	Lenke classification	RZ*
11	57	F	-0.98	spinal stenosis	L3-4,4-5	Grafton	B
12	66	F	-0.98	spinal stenosis	L2-3,3-4,4-5	Orthoblast II	C
13	72	F	-2.08	spondylolisthesis	L4-5, L5-S1	Orthoblast II	B
14	64	F	-1.35	spinal stenosis	L4-5, L5-S1	Grafton	B
15	48	F	-0.36	spondylolisthesis	L4-5, L5-S1	Orthoblast II	D	+
16	74	F	-2.09	spinal stenosis	L4-5	Grafton	C
17	55	F	-0.40	deg. scoliosis	L2-3,3-4,4-5	Grafton	C	+
18	75	F	-0.85	spondylolisthesis	L3-4,4-5	Orthoblast II	B
19	35	F	0.42	spondylolisthesis	L5-S1	Grafton	A
10	63	F	-1.52	spondylolisthesis	L4-5, L5-S1	Grafton	C	+
11	58	M	-0.65	spinal stenosis	L4-5	Grafton	B
12	60	M	-1.84	spinal stenosis	L4-5	Grafton	D	+
13	76	M	0.11	spinal stenosis	L4-5, L5-S1	Orthoblast II	B
14	69	F	-1.63	deg. scoliosis	L2-3,3-4,4-5	Orthoblast II	B
15	57	M	-1.10	spondylolisthesis	L4-5	Grafton	D	+
16	61	F	-2.87	spinal stenosis	L3-4,4-5	Grafton	C
17	62	F	-1.59	spinal stenosis	L3-4,4-5	Orthoblast II	A
18	67	M	0.53	deg. scoliosis	L2-3,3-4,4-5	Grafton	C	+
19	70	F	-1.57	spinal stenosis	L4-5	Orthoblast II	B
20	82	F	0.41	spinal stenosis	L3-4,4-5	Grafton	D	+
21	53	F	0.53	spinal stenosis	L2-3,3-4,4-5	Orthoblast II	C
22	64	M	0.99	spinal stenosis	L4-5	Orthoblast II	B
23	69	F	-1.71	spondylolisthesis	L3-4,4-5	Grafton	B
24	69	M	-1.04	spinal stenosis	L4-5, L5-S1	Orthoblast II	C
25	59	F	-1.50	spinal stenosis	L2-3,3-4	Grafton	B
26	76	F	-3.21	spondylolisthesis	L3-4,4-5	Orthoblast II	B
27	62	F	-0.75	spinal stenosis	L4-5, L5-S1	Grafton	A
28	83	F	-3.76	spondylolisthesis	L4-5	Orthoblast II	B
29	67	M	-1.53	spondylolisthesis	L3-4,4-5	Orthoblast II	C	+
30	70	F	-2.45	spinal stenosis	L4-5	Grafton	C
31	67	M	-0.93	deg. scoliosis	L2-3,3-4,4-5	Orthoblast II	D	+
32	55	F	-2.55	spondylolisthesis	L4-5	Grafton	B
33	56	F	1.64	spinal stenosis	L4-5	Orthoblast II	A
34	83	F	-1.82	spondylolisthesis	L5-S1	Grafton	B
35	51	F	-0.52	spinal stenosis	L4-5, L5-S1	Orthoblast II	B
36	68	M	-1.60	spinal stenosis	L4-5, L5-S1	Orthoblast II	C	+
37	73	M	0.70	spinal stenosis	L5-S1	Orthoblast II	B
38	77	F	-1.67	spondylolisthesis	L4-5, L5-S1	Grafton	A
39	68	F	-1.53	spondylolisthesis	L4-5	Grafton	B
40	61	F	-2.51	spondylolisthesis	L3-4,4-5	Orthoblast II	D	+
41	69	F	-0.49	spinal stenosis	L4-5	Orthoblast II	C	+
42	69	F	-3.57	spinal stenosis	L4-5	Grafton	B
43	81	F	-1.81	spinal stenosis	L2-3,3-4	Grafton	A
44	75	F	-1.53	spondylolisthesis	L3-4,4-5, L5-S1	Grafton	A
45	63	F	-1.46	spinal stenosis	L5-S1	Orthoblast II	B
46	71	F	-2.87	spinal stenosis	L4-5	Grafton	C
47	82	F	-2.79	deg. scoliosis	L3-4,4-5, L5-S1	Orthoblast II	C	+
48	76	F	-4.12	spondylolisthesis	L4-5, L5-S1	Grafton	C
49	75	F	-3.11	spondylolisthesis	L4-5	Orthoblast II	B

^∗ : radiolucent zone surrounding pedicle screw

Table 2.

Fusion status according to number of fusion segments

No. of fusion segment	Lenke classification	Group I	Group II	p-value
	A	12	13
1 segment	B	11	10	0.062
	C	14	14
	D	12	11
	A	14	14
2 segments	B	19	14	0.282
	C	16	15
	D	13	11
	A	11	12
3 segments	B	11	12	0.112
	C	15	12
	D	11	11
	A	10	10
4 segments	B	10	10	—
	C	10	11
	D	10	10
Total		49	50	0.317

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