Biphasic Calcium Phosphate and Local Autobone Mixed Graft in Lumbar Posterolateral Fusion

Jung-Wook Huh; Young-Chul Ko; Chul-Young Jung; Il-Soo Eun; Man-Jun Park; Min-Woo Kim; Keum-Min Hwang; Sook-Hyun Park

doi:10.4184/jkss.2014.21.3.103

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Huh, Ko, Jung, Eun, Park, Kim, Hwang, and Park: Biphasic Calcium Phosphate and Local Autobone Mixed Graft in Lumbar Posterolateral Fusion

Original Article

Journal of Korean Spine Surg 2014;21(3):103-108.

Published online: 21 September 2014

DOI: https://doi.org/10.4184/jkss.2014.21.3.103

Biphasic Calcium Phosphate and Local Autobone Mixed Graft in Lumbar Posterolateral Fusion

Jung-Wook Huh, M.D., Young-Chul Ko, M.D., Chul-Young Jung, M.D., Il-Soo Eun, M.D., Man-Jun Park, M.D., Min-Woo Kim, M.D., Keum-Min Hwang, M.D., Sook-Hyun Park, M.D.

Department of Orthopedic Surgery, Busan Medical Center, Busan, Korea

Corresponding author: Young-Chul Ko, M.D. Department of Orthopedic Surgery, Busan Medical Center, Busan, Korea TEL: +82-51-607-2866, FAX: +82-51-607-2551 E-mail: drkimminwoo@naver.com

Received 25 May 2014 Revised 26 May 2014 Accepted 15 September 2014

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

Retroprospective study.

Objectives

To evaluate the efficacy of biphasic calcium phosphate and local autobone mixed graft in cases of spinal stenosis and spondylolisthesis in posterolateral fusion by examining radiologic union rates and clinical outcomes.

Summary of Literature Review

It can be a practical alternative to the use of tricalcium phosphate in hydroxyapatite as a graft aid since using hydroxyapatite mixture in lumbar spine fusion has been reported to lead to a high rate of bone union.

Materials and Methods

From July 2011 to February 2013, we followed up 107 patients who had lumbar posterolateral fusion using biphasic calcium phosphate composed of HA/TCP (60:40) and local autobone mixed graft. Of these patients, 64 had spinal stenosis and 43 had spondylolisthesis. The bone fusion rate was determined using Lenke's criteria and clinical outcomes were evaluated using Kim's method.

Results

In spinal stenosis, bone union was presented in 53 patients (of 64; 82.8%) and in spondylolisthesis, 35 patients (of 43; 81.4%). In spinal stenosis, the clinical outcomes resulted in 20 excellent, 34 good, 9 fair and 1 poor. (84.4%, excellent or good) In spondylolisthesis, the clinical outcomes resulted in 10 excellent, 25 good, 7 fair and 1 poor. (81.4%, excellent or good)

Conclusion

Posterolateral fusion using biphasic calcium phosphate and local autobone mixed graft showed high rates of bone union and acceptable clinical outcomes, and is considered a satisfactory bone graft aid.

Keywords: Spinal stenosis, Spondylolisthesis, Biphasic calcium phosphate, Posterolateral fusion

REFERENCES

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Figures and Tables%

Fig. 1.

71-year-old male in patient with spinal stenosis L3-5, postoperative radiograph (A) and 3D reconstruction CT (B) demonstrated solid bony union grafted with biphasic calcium phosphate (Osspol^Ⓡ) at postoperative 17 months.

Table 1.

Bone Fusion Rates by Lenke's Criteria

	Spinal stenosis	Spondylolisthesis	Total
A	25(39.0%)	16(37.2%)	41(38.3%)
B	28(43.6%)	19(44.2%)	47(43.9%)
C	10(15.6%)	7(16.3%)	17(15.9%)
D	1(1.6%)	1(2.3%)	2(1.9%)
Total	64(100%)	43(100%)	107(100%)

Table 2.

Patients’ Demographics

	Union group (n=88, 82.2%)	Non-union group (n=19, 17.8%)	p-value
Age	62.8 ± 7.7	62.9 ± 9.4	0.978
Diagnosis			NS
Spinal stenosis	53(60.2%)	11(57.9%)
Spondylolisthesi	is 35(39.8%)	8(42.1%)
Fusion level
1-2	76(86.4%)	12(63.2%)	0.024
3-4	12(13.6%)	7(36.8%)	0.010
Osteoporosis (T-score≤-2.5)	57(64.8%)	9(47.4%)	0.196
Smoking	18(20.5%)	3(15.8%)	0.760

Table 3.

Data Analysis According to Union

	Hazard ratio	95% CI	p-value
Old age (≥65 age)	0.707	0.214-0.233	0.568
Multilevel fusion (≥3 level)	0.278	0.886-0.898	0.032
Osteoporosis (T-score≤-2.5)	0.417	0.121-1.145	0.165
Smoking	0.420	0.096-1.831	0.248

*CI : Confidence interval.

Table 4.

Clinical Results by Kim's Criteria

	Spinal stenosis	Spondylolisthesis	Total
Excellent	20(31.3%)	10(23.3%)	30(28.0%)
Good	34(53.1%)	25(58.1%)	59(55.1%)
Fair	9(14.1%)	7(16.3%)	16(15.0%)
Poor	1(1.5%)	1(2.3%)	2(1.9%)
Total	64(100%)	43(100%)	107(100%)

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