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Abstract
Study design
This is a prospective study to determine whether calcium sulfate(CS) used as a bone graft expander could pro-mote 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(A GB).
Semmary and Literature Review
A utogenous 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 A GB were evaluated. The patients received the autogenous iliac crest graft on one side of the spine and an equivalent vol-ume 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 radiog-raphy and CT.
Results
Of 47 segments fused with CS and A GB, 42 segments (89.4%) were completely fused. In contrast, segments fused with A GB 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 A BG. 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.
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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.
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.
Fig. 3.
Showing multiple pores in CS mixed with AGB site(Rt) as compared with autogenous graft(Lt) on gross findings.
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
Table 1.
Summary of Clinical Data
∗ FBSS : Failed back surgery syndrome () : numeric number means nonunion segment Cx. : complication Assessment of fusion according to Lenke’s classification A : Indicates a big, solid trabeculated bilateral fusion mass(definitely solid) Β : Big, solid unilateral fusion mass with a small controlateral fusion mass(possibly not solid) C : Small, thin bilateral fusion mass with an apparent crack(possibly not solid) D : Bilateral resorption of the graft with an obvious bilateral pseudoarthrosis(not solid)
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