Union Patterns of Local Autogenous Bone Grafts Using Metal Cages, Allogenic Bone, and Local Autogenous Bone Around the Cages During Posterior Lumbar Interbody Fusion: A Retrospective CT Analysis

Chan Ho Park; Eung-Ha Kim; Keonhee Yun

doi:10.4184/jkss.2017.24.2.87

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Park, Kim, and Yun: Union Patterns of Local Autogenous Bone Grafts Using Metal Cages, Allogenic Bone, and Local Autogenous Bone Around the Cages During Posterior Lumbar Interbody Fusion: A Retrospective CT Analysis

Original Article

Journal of Korean Spine Surg 2017;24(2):87-94.

Published online: 30 June 2017

DOI: https://doi.org/10.4184/jkss.2017.24.2.87

Union Patterns of Local Autogenous Bone Grafts Using Metal Cages, Allogenic Bone, and Local Autogenous Bone Around the Cages During Posterior Lumbar Interbody Fusion: A Retrospective CT Analysis

Chan Ho Park, M.D., Eung-Ha Kim, M.D., Ph.D.^∗,, Keonhee Yun, M.D.^∗

Department of Orthopedic Surgery, Yeungnam University Hospital, Daegu, Korea

^∗Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea

Corresponding author: Eung-Ha Kim, M.D., Ph.D. ORCID ID: 0000-0003-4615-4163 Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon, Gyeonggi-do, of Korea TEL: +82-32-621-5259, FAX: +82-32-324-9577 E-mail: eungha@gmail.com

Received 2 February 20177 February 2017 Accepted 30 May 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

Retrospective study.

Objectives

To conduct an analysis of the union rate and union patterns of local autogenous bone grafts using metal cages, allogenic bone, and local autogenous bone around the cages in posterior lumbar interbody fusion (PLIF).

Summary of Literature Review

Local autologous bone grafting using metal cages is regarded as an effective method for union during PLIF without iliac bone harvesting. There are few studies about the additional bone grafting except using metal cages.

Materials and Methods

Thirty-nine patients (68 segments) with postoperative computed tomography (CT) results from 6 to 18 months after PLIF were included. We used 2 metal cages filled with local autogenous bone intraoperatively (region C). We also grafted allogenic bone between 2 cages (region A) and local autogenous bone at the side of the cages (region B). Retrospective analyses of the coronal CT sections were performed using the modified Bridwell criteria for assessing the presence of union. A quantitative evaluation was performed using a scoring system that assessed the proportion of radiopaque parts of the union mass.

Results

Among the 68 segments, union was observed in 64 segments, resulting in a union rate of 95.6%. The union rates in regions A, B, and C were 86.8%, 89.7%, and 94.1%, respectively. Trabeculation and the quantitative evaluation of union bone showed a statistically significant trend for improvement from regions A to C (p<0.001).

Conclusions

In this study, the complementary effect of additional bone grafting other than local bone grafting was not proven, but it was effective in increasing the fusion area at around 90%. Keeping the height of disc space with the cages, additional bone grafting using local autogenous and allogenous bone may be used as an effective method for stable union.

Keywords: Lumbar spondylosis, Posterior lumbar interbody fusion, Allogenic bone, Local autologous bone, Union rate

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Fig. 1.

The method of laminectomy and bone grafting was like as below diagram. (A) Allogenic bone between cages, (B) Local autogenous bone, (C) Local autogenous bone using cages.

Fig. 2.

Measurement of radiopaque area in union bone by software pro-gram (between 0 to 80 Hounsfield unit).

Fig. 3.

Proportions of the Bridwell of trabeculation (A) and the density scores (B) in each region.

Fig. 4.

(A) 77-year-old woman showed the trabeculation of Bridwell grade IV in region A of L4-5 after 12 months of posterior lumbar interbody fusion. (B) After the another 12 months, solid union of Bridwell grade I in region A was obtained.

Fig. 5.

Sagittal images also showed the long axis of union bone that had superior tendency of quantitative evaluation from C region to A region.

Table 1.

Comparison of trabeculation by Bridwell criteria

	Grade I	Grade II	Grade III	Grade IV	p-value^†
A region	10(14.7)	49(72.1)	7(10.3)	2(2.9)
B region	28(41.2)	33(48.5)	5(7.4)	2(2.9)	<0.001
C region	37(54.4)	27(39.7)	2(2.9)	2(2.9)

^∗ :All values are described as frequency (%)

^† : p-value was calculated by Jonckneere-Terpstra test (alternative hypothesis; decreasing).

Table 2.

Comparison of density by scoring system

	3	2	1	0	p-value^†
A region	3(4.4)	35(51.5)	25(36.8)	5(7.4)
B region	16(23.5)	38(55.9)	12(17.6)	2(2.9)	<0.001
C region	28(41.2)	29(42.6)	11(16.2)	0(0)

^∗ : All values are described as frequency (%)

^† : p-value was calculated by Jonckneere-Terpstra test (alternative hypothesis; increasing).

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