Journal List > J Korean Soc Spine Surg > v.14(4) > 1035783

TOOLS
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

Copyright © 2007 Korean Society of Spine Surgery

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.

Go to : Goto

Keywords: Demineralized bone matrix, Posterolateral fusion

REFERENCES

1). Lee YP, Jo M, Luna M, Chien B, Lieberman JR, Wang JC. The efficacy of different commercially available demineralized bone matrix substances in an athymic rat model. J Spinal Disord Tech. 2005; 18:439–444.
crossref
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.
crossref
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.
4). Lee KJ, Roper JG, Wang JC. Demineralized bone matrix and spinal arthrodesis. Spine J. 2005; 5:217–223.
crossref
5). Urist MR. Bone formation by autoinduction. Science. 1965; 150:893–899.
crossref
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.
crossref
8). Price CT, Connolly JF, Carantzas AC, Ilyas I. Comparison of bone graft for posterior spinal fusion in adolescent idiopathic scoliosis. Spine. 2003; 28:793–798.
9). Vaccaro AR, Chiba K, Heller JG, et al. Bone grafting alternatives in spinal surgery. Spine J. 2002; 2:206–215.
crossref
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.
crossref
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.
crossref
12). McLain RF, Fleming JE, Boehm CA, Muschler GF. Aspiration of osteoprogenitor cells for augmenting spinal fusion: comparison of progenitor cell concentration from the vertebral body and iliac crest. J Bone Joint Surg Am. 2005; 87:2655–2661.
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.
15). Wang JC, Alanny A, Mark D, Kanim LE, et al. A comparison of commercially available demineralized bone matrix for spinal fusion: Eur Spine J. 2007; 16:1233–1240.
Go to : Goto

Figures and Tables%

jkss-14-256f1.tif
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.
undefined
jkss-14-256f2.tif
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.
undefined
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
TOOLS
Similar articles