Local autogenous bone mixed with bone expander: an optimal option of bone graft in single-segment posterolateral lumbar fusion

Abstract

Background This was a retrospective study of clinical results for single-segment posterolateral lumbar fusion using local autograft bone with bone expander. Methods Sixty-six patients underwent single-segment decompression with instrumented posterolateral fusion. Locally harvested morselized bone from the decompressive site mixed with 2 mL calcium sulfate (OSTEOSET, Wright Medical Technology, Arlington, TN, USA) was used for the fusion at the posterolateral aspect of the lumbar spine. The minimum follow-up period was 15 months. The status of the fusion was evaluated by plain film, flexion-extension view, and fine-cut computed tomography (CT) with coronal reconstruction. Radiographic fusion criteria included less than 5° of angular motion, less than 2 mm of translation, and evidence of bridging bone in the posterolateral lumbar area on the CT scan. The clinical outcome was recorded using VAS score and the ODI. The results were then compared with the result of the other group who had received the same procedure except that a pure autogenous bone graft harvested from the PSIS was used. Results In the group using local bone and OSTEOSET, the fusion rate was 92.3% by the strict criteria. The VAS scores for leg pain and back pain were decreased in the 2 groups, but there was no significant difference between them. The improvement in the ODI was also similar between the 2 groups. Intraoperative blood loss and the time needed for the operation were significantly decreased in the group using local bone and OSTEOSET as the bone graft. In the group using autogenous bone graft, donor site morbidity was still encountered. Conclusions Using local laminectomy bone with calcium sulfate as bone graft is a practical option in posterolateral lumbar fusion with the advantages of less operative time, less blood loss, and avoidance of donor site morbidity.