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Abstract
Purpose
The purpose of this study is to analyze the effects of demineralized bone matrix on posterolateral lumbar fusion.
Materials and Methods
From 2009 to 2012, 30 patients who had undergone posterolateral fusions using demineralized bone matrix (group I) and 30 who had received autogenous posterior iliac bone grafts (group II) were investigated. Bone union was determined by evaluating serial simple lumbar radiographs taken during the 24 months after surgery. Bone status was classified according to Lenke's scale and the bone fusion was finally determined by flexion/extension lateral radiographs. We also examined halo signs around the pedicular screws evident on the radiographs, scored back pain using a visual analogue scale (VAS), and Oswestry disability index (ODI) score 2 years after surgery to evaluate clinical status of patients.
Results
In group I, 19 patients showed union and 11 patients did not; the values for group II were 22 and 8. These proportions did not differ significantly (p=0.57). Time to union was somewhat shorter in group II (25.3±7.9 weeks), but did not differ significantly from that of group I (p=0.097). No statistical significance in the periscrew Halo count, VAS for back pain, and ODI score was observed between the two groups.
Conclusion
The union rate after using demineralized bone matrix for lumbar posterolateral fusion is similar to that attained when autogenous bone grafts are employed, and lacks the morbidity associated with such grafts. Thus, demineralized bone matrix is an effective bone graft substitute when posterolateral fusion surgery of the lumbar spine is required.
Figures and Tables
Fig. 1
A 71-year-old female with degenerative lumbar disease underwent surgery with posterior decompression and posterolateral fusion using autogenous posterior iliac bone graft mixed with local bone. (A) Initial anteroposterior and lateral radiographs show degenerative lumbar disease with L4–5 anterolisthesis. (B) Postoperative anteroposterior and lateral radiographs show that the posterior laminectomy and posterolateral fusions were done on the level of L3–4–5–S1. (C) At 30 weeks after the operation, anteroposterior and lateral radiographs show that the fusion mass was formed bilaterally, which was defined as Lenke's scale A. (D) There was no significant translation and angulation on the flexion-extension lateral radiographs at 30 weeks after surgery.
Table 1
Lenke's Scale*
*Data from the article of Lenke et al. (J Bone Joint Surg Am. 1992;74:1056-67).25)
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