Abstract
BackgroundAlthough autogenous iliac bone graft (AIBG) remains the gold standard for spine fusion, harvesting morbidity has prompted the search for alternatives especially for multi-segment fusion. This study aimed to evaluate the efficacy of using demineralized bone matrix (DBM) as a substitute of AIBG for long instrumented posterolateral fusion (≧ three-level fusion).MethodsA total of 47 consecutive patients underwent laminectomy decompression, and multi-level instrumented posterolateral fusions were reviewed. Group 1 comprised 26 patients having DBM with autologous laminectomy bone (ALB). Group 2 consisted of 21 patients having AIBG with ALB. The fusion success evaluation was based on findings using the 12-month anteroposterior and dynamic plain radiographs.ResultsGender, age, and the number of fusion levels were similar for both groups. 21 of 26 (80.8 %) patients in group 1 and 18 of 21 (85.7 %) patients in group 2 were observed to achieve solid bony fusion. There was no statistical difference in the fusion success (p = 0.72). Blood loss was significantly more in group 2 (p = 0.02). The duration of the hospital stays and operative times being longer for group 2, but the difference was not significant.ConclusionsDBM combined with ALB and osteoconductive materials is as effective as an autologous iliac bone graft with respect to long multi-segment posterolateral fusion success. DBM can be used as an effective bone graft substitute and may decrease morbidities associated with iliac bone graft harvest.
Highlights
Autogenous iliac bone graft (AIBG) remains the gold standard for spine fusion, harvesting morbidity has prompted the search for alternatives especially for multi-segment fusion
For one- or two-level short instrumented posterolateral fusion, our previous studies showed that autologous laminectomy bone (ALB) with synthetic osteoconductive material achieved high fusion success [4]
Age, transforaminal lumbar interbody fusion (TLIF)/posterior lumbar interbody fusion (PLIF) procedures, and the number of fusion levels were similar for both groups (Table 1)
Summary
Autogenous iliac bone graft (AIBG) remains the gold standard for spine fusion, harvesting morbidity has prompted the search for alternatives especially for multi-segment fusion. This study aimed to evaluate the efficacy of using demineralized bone matrix (DBM) as a substitute of AIBG for long instrumented posterolateral fusion (≧ three-level fusion). Successful surgical management of spine instability often requires bone grafting for fusion. Autogenous iliac bone graft (AIBG) remains the gold standard for successful spine fusion. There are many different types of bone graft substitutes. For one- or two-level short instrumented posterolateral fusion, our previous studies showed that autologous laminectomy bone (ALB) with synthetic osteoconductive material achieved high fusion success [4]. Steffen et al reported that posterolateral fusions demand approximately 15 mL of compacted bone per
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