Abstract
BackgroundInstrumented posterior lumbar fusion (IPLF) with and without transforaminal interbody fusion (TLIF) is a common treatment for low back pain when conservative interventions have failed. Certain patient comorbidities and lifestyle risk factors, such as obesity and smoking, are known to negatively affect these procedures. An advanced cellular bone allograft (CBA) with viable osteogenic cells (V-CBA) has demonstrated high fusion rates, but the rates for patients with severe and/or multiple comorbidities remain understudied. The purpose of this study was to assess fusion outcomes in patients undergoing IPLF/TLIF using V-CBA with baseline comorbidities and lifestyle risk factors known to negatively affect bone fusion.MethodsThis was a retrospective study of de-identified data from consecutive patients at an academic medical center who underwent IPLF procedures with or without TLIF, and with V-CBA. Baseline patient and procedure characteristics were assessed. Radiological outcomes included fusion rates per the Lenke scale. Patient-reported clinical outcomes were evaluated via the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for back and leg pain. Operating room (OR) times and intraoperative blood loss rates were also assessed.ResultsData from 96 patients were assessed with a total of 222 levels treated overall (mean: 2.3 levels) and a median follow-up time of 16 months (range: 6 to 45 months). Successful fusion (Lenke A or B) was reported for 88 of 96 patients (91.7%) overall, including in all IPLF-only patients. Of 22 patients with diabetes in the IPLF+TLIF group, fusion was reported in 20 patients (90.9%). In IPLF+TLIF patients currently using tobacco (n = 19), fusion was reported in 16 patients (84.3%), while in those with a history of tobacco use (n = 53), fusion was observed in 48 patients (90.6%). Successful fusion was reported in all 6 patients overall with previous pseudarthrosis at the same level. Mean postoperative ODI and VAS scores were significantly reduced versus preoperative ratings.ConclusionThe results of this study suggest that V-CBA consistently yields successful fusion and significant decreases in patient-reported ODI and VAS, despite patient comorbidities and lifestyle risk factors that are known to negatively affect such bony healing.
Highlights
Instrumented posterior lumbar fusion (IPLF) with and without transforaminal interbody fusion (TLIF) is a common treatment for low back pain when conservative interventions have failed
The purpose of this study was to retrospectively assess clinical outcomes in patients undergoing IPLF surgeries with and without TLIF and using V-cellular bone allograft (CBA), who had baseline comorbidities and lifestyle risk factors known to negatively affect bone fusion. Patients and variables This was a retrospective study of de-identified data from consecutive patients undergoing IPLF procedures with or without TLIF performed by the first author (HE) using V-CBA at an academic medical center from January 2016 to November 2018
An overall total of 36 patients (37.5%) had previously undergone lumbar spine surgery: Index revision surgery for pseudarthrosis was performed in 6 patients (6.3%) overall, adjacent or other segment degeneration in 9 patients (9.4%), and 21 patients (21.9%) had non-fusion lumbar surgical procedures, such as microdiscectomy and laminectomy for decompression
Summary
Instrumented posterior lumbar fusion (IPLF) with and without transforaminal interbody fusion (TLIF) is a common treatment for low back pain when conservative interventions have failed. The purpose of this study was to assess fusion outcomes in patients undergoing IPLF/TLIF using V-CBA with baseline comorbidities and lifestyle risk factors known to negatively affect bone fusion. IPLF/TLIF surgeries are known to be negatively affected by certain patient comorbidities and lifestyle risk factors, such as obesity and smoking, which can slow or prevent fusion [5,6,7]. Successful bone fusion requires three main properties: an osteoconductive scaffold to support it, osteoinductive molecular signals to promote it, and osteogenic cells to facilitate it [8] Autologous bone, such as iliac crest bone graft (ICBG), is the traditionally-preferred source of these properties [8]. Numerous alternatives to autograft bone, including allogeneic bone, have emerged with the goal of facilitating bone formation while limiting the inherent drawbacks of autograft
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