Abstract
BackgroundThis study aimed to assess the surgical outcomes of two kinds of demineralized bone matrix (DBM) putties/local autograft composites in instrumented posterolateral lumbar fusion (PLF).MethodsTwenty-seven fusion segments of 19 patients, who underwent decompression and instrumented PLF for lumbar spinal stenosis or degenerative spondylolisthesis less than grade 1, were included in this study. The PLF mass consisted of different two kinds of DBMs (Grafton® and DBX®) and local autograft. Next, 7.5 cc of Grafton® DBM/local autograft composite was implanted on the left side, and the same amount of DBX® DBM/local autograft composite was implanted on the right side in the same patient. The PLF masses of 54 total sides (27 Grafton® sides and 27 DBX® sides) were assessed for fusion based on both flexion/extension lateral radiographs and computed tomography images at 12 and 24 months postoperatively. Clinical symptoms were also evaluated.ResultsAt 12 months postoperatively, the fusion rates for the Grafton® and DBX® sides were 59.5 and 51.9%, respectively; the difference was not statistically significant (P = 0.425). At 24 months postoperatively, the fusion rates for the Grafton® and DBX® sides increased to 70.4 and 66.7%, respectively, but the difference was still not statistically significant (P = 0.574). Diabetes mellitus, smoking, and obesity (body mass index ≥25) negatively affected the fusion rate of both the Grafton® and DBX® sides. Visual analog scores for lower back pain and leg pain and Oswestry Disability Index were significantly improved after surgery (both, P < 0.01). No deep or superficial infections occurred postoperatively. No patients underwent revision surgery due to nonunion during follow-up.ConclusionsOur results suggest that two kinds of DBMs/local autograft composites might be considered as useful bone graft substitute in instrumented posterolateral fusion for lumbar spinal stenosis or degenerative spondylolisthesis less than grade 1.
Highlights
This study aimed to assess the surgical outcomes of two kinds of demineralized bone matrix (DBM) putties/local autograft composites in instrumented posterolateral lumbar fusion (PLF)
Lumbar spinal fusion procedures are usually performed for lumbar degenerative diseases when preoperative instability is present or when postoperative instability is expected due to the extensive decompression required during surgery [1,2,3,4,5,6,7,8]
These previous studies have shown that commercially available DBM products exhibit significant variability in fusion performance, which is secondary to their differences in carrier medium and processing [24, 34]
Summary
This study aimed to assess the surgical outcomes of two kinds of demineralized bone matrix (DBM) putties/local autograft composites in instrumented posterolateral lumbar fusion (PLF). Potential alternatives to autologous ICBG, including local autograft, calcium-phosphate salts, demineralized bone matrix (DBM), the bone morphogenetic proteins (BMP) family, autogenous growth factors, bone marrow aspirate, and collagen base matrices, are gaining popularity and are being increasingly used in lumbar spinal fusion procedures [1,2,3,4,5,6,7]. The osteoinductive potential of allogeneic DBM has been studied as an alternative bone graft materials. There are several commercially available DBMs according to the carriers, especially hyaluronic acid (DBX®) carriers and glycerol carriers (Grafton®) and the form of the carrier choice of DBM may cause a difference of surgical outcomes
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