Browse > Article
http://dx.doi.org/10.3340/jkns.2016.59.4.363

Matched Comparison of Fusion Rates between Hydroxyapatite Demineralized Bone Matrix and Autograft in Lumbar Interbody Fusion  

Kim, Dae Hwan (Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine)
Lee, Nam (Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine)
Shin, Dong Ah (Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine)
Yi, Seong (Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine)
Kim, Keung Nyun (Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine)
Ha, Yoon (Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine)
Publication Information
Journal of Korean Neurosurgical Society / v.59, no.4, 2016 , pp. 363-367 More about this Journal
Abstract
Objective : To compare the fusion rate of a hydroxyapatite demineralized bone matrix (DBM) with post-laminectomy acquired autograft in lumbar interbody fusion surgery and to evaluate the correlation between fusion rate and clinical outcome. Methods : From January 2013 to April 2014, 98 patients underwent lumbar interbody fusion surgery with hydroxyapatite DBM (HA-DBM group) in our institute. Of those patients, 65 received complete CT scans for 12 months postoperatively in order to evaluate fusion status. For comparison with autograft, we selected another 65 patients who underwent lumbar interbody fusion surgery with post-laminectomy acquired autograft (Autograft group) during the same period. Both fusion material groups were matched in terms of age, sex, body mass index (BMI), and bone mineral density (BMD). To evaluate the clinical outcomes, we analyzed the results of visual analogue scale (VAS), Oswestry Disability Index (ODI), and Short Form Health Survey (SF-36). Results : We reviewed the CT scans of 149 fusion levels in 130 patients (HA-DBM group, 75 levels/65 patients; Autograft group, 74 levels/65 patients). Age, sex, BMI, and BMD were not significantly different between the groups (p=0.528, p=0.848, p=0.527, and p=0.610, respectively). The HA-DBM group showed 39 of 75 fused levels (52%), and the Autograft group showed 46 of 74 fused levels (62.2%). This difference was not statistically significant (p=0.21). In the HA-DBM group, older age and low BMD were significantly associated with non-fusion (61.24 vs. 66.68, p=0.027; -1.63 vs. -2.29, p=0.015, respectively). VAS and ODI showed significant improvement after surgery when fusion was successfully achieved in both groups (p=0.004, p=0.002, HA-DBM group; p=0.012, p=0.03, Autograft group). Conclusion : The fusion rates of the hydroxyapatite DBM and Autograft groups were not significantly different. In addition, clinical outcomes were similar between the groups. However, older age and low BMD are risk factors that might induce non-union after surgery with hydroxyapatite DBM.
Keywords
Hydroxyapatite; Autograft; Fusion; CT scan;
Citations & Related Records
Times Cited By KSCI : 1  (Citation Analysis)
연도 인용수 순위
1 Okuyama K, Abe E, Suzuki T, Tamura Y, Chiba M, Sato K : Influence of bone mineral density on pedicle screw fixation : a study of pedicle screw fixation augmenting posterior lumbar interbody fusion in elderly patients. Spine J 1 : 402-407, 2001   DOI
2 Suetsuna F, Yokoyama T, Kenuka E, Harata S : Anterior cervical fusion using porous hydroxyapatite ceramics for cervical disc herniation. A two-year follow-up. Spine J 1 : 348-357, 2001   DOI
3 Tan GH, Goss BG, Thorpe PJ, Williams RP : CT-based classification of long spinal allograft fusion. Eur Spine J 16 : 1875-1881, 2007   DOI
4 Thalgott JS, Giuffre JM, Fritts K, Timlin M, Klezl Z : Instrumented posterolateral lumbar fusion using coralline hydroxyapatite with or without demineralized bone matrix, as an adjunct to autologous bone. Spine J 1 : 131-137, 2001   DOI
5 Yi J, Lee GW, Nam WD, Han KY, Kim MH, Kang JW, et al. : A prospective randomized clinical trial comparing bone union rate following anterior cervical discectomy and fusion using a polyetheretherketone cage : hydroxyapatite/B-tricalcium phosphate mixture versus hydroxyapatite/demineralized bone matrix mixture. Asian Spine J 9 : 30-38, 2015   DOI
6 Antoni M, Charles YP, Walter A, Schuller S, Steib JP : Fusion rates of different anterior grafts in thoracolumbar fractures. J Spinal Disord Tech 28 : E528-E533, 2015   DOI
7 Agrillo U, Mastronardi L, Puzzilli F : Anterior cervical fusion with carbon fiber cage containing coralline hydroxyapatite : preliminary observations in 45 consecutive cases of soft-disc herniation. J Neurosurg 96 (3 Suppl) : 273-276, 2002
8 An HS, Simpson JM, Glover JM, Stephany J : Comparison between allograft plus demineralized bone matrix versus autograft in anterior cervical fusion. A prospective multicenter study. Spine (Phila Pa 1976) 20 : 2211-2216, 1995   DOI
9 Andersen T, Christensen FB, Laursen M, Hoy K, Hansen ES, Bunger C : Smoking as a predictor of negative outcome in lumbar spinal fusion. Spine (Phila Pa 1976) 26 : 2623-2628, 2001   DOI
10 Bak B, Andreassen TT : The effect of aging on fracture healing in the rat. Calcif Tissue Int 45 : 292-297, 1989   DOI
11 Boden SD : Bone repair and enhancement clinical trial design. Spine applications. Clin Orthop Relat Res (355 Suppl) : S336-S346, 1998
12 Bono CM, Lee CK : Critical analysis of trends in fusion for degenerative disc disease over the past 20 years : influence of technique on fusion rate and clinical outcome. Spine (Phila Pa 1976) 29 : 455-463; discussion Z5, 2004   DOI
13 Finkemeier CG : Bone-grafting and bone-graft substitutes. J Bone Joint Surg Am 84-A : 454-464, 2002
14 Cammisa FP Jr, Lowery G, Garfin SR, Geisler FH, Klara PM, McGuire RA, et al. : Two-year fusion rate equivalency between Grafton DBM gel and autograft in posterolateral spine fusion : a prospective controlled trial employing a side-by-side comparison in the same patient. Spine (Phila Pa 1976) 29 : 660-666, 2004   DOI
15 Carreon LY, Glassman SD, Djurasovic M : Reliability and agreement between fine-cut CT scans and plain radiography in the evaluation of posterolateral fusions. Spine J 7 : 39-43, 2007   DOI
16 Dimar JR, Glassman SD, Burkus KJ, Carreon LY : Clinical outcomes and fusion success at 2 years of single-level instrumented posterolateral fusions with recombinant human bone morphogenetic protein-2/compression resistant matrix versus iliac crest bone graft. Spine (Phila Pa 1976) 31 : 2534-2539; discussion 2540, 2006   DOI
17 Glassman SD, Alegre G, Carreon L, Dimar JR, Johnson JR : Perioperative complications of lumbar instrumentation and fusion in patients with diabetes mellitus. Spine J 3 : 496-501, 2003   DOI
18 Glassman SD, Carreon L, Djurasovic M, Campbell MJ, Puno RM, Johnson JR, et al. : Posterolateral lumbar spine fusion with INFUSE bone graft. Spine J 7 : 44-49, 2007   DOI
19 Inoue K, Ohgushi H, Yoshikawa T, Okumura M, Sempuku T, Tamai S, et al. : The effect of aging on bone formation in porous hydroxyapatite : biochemical and histological analysis. J Bone Miner Res 12 : 989-994, 1997   DOI
20 Ito Z, Matsuyama Y, Sakai Y, Imagama S, Wakao N, Ando K, et al. : Bone union rate with autologous iliac bone versus local bone graft in posterior lumbar interbody fusion. Spine (Phila Pa 1976) 35 : E1101-E1105, 2010   DOI
21 Lee HS, Lee JH, Lee JH : A comparison of dynamic views using plain radiographs and thin-section three-dimensional computed tomography in the evaluation of fusion after posterior lumbar interbody fusion surgery. Spine J 13 : 1200-1207, 2013   DOI
22 Kang J, An H, Hilibrand A, Yoon ST, Kavanagh E, Boden S : Grafton and local bone have comparable outcomes to iliac crest bone in instrumented single-level lumbar fusions. Spine (Phila Pa 1976) 37 : 1083-1091, 2012   DOI
23 Ko KI, Coimbra LS, Tian C, Alblowi J, Kayal RA, Einhorn TA, et al. : Diabetes reduces mesenchymal stem cells in fracture healing through a $TNF{\alpha}$-mediated mechanism. Diabetologia 58 : 633-642, 2015   DOI
24 Koerner JD, Yalamanchili P, Munoz W, Uko L, Chaudhary SB, Lin SS, et al. : The effects of local insulin application to lumbar spinal fusions in a rat model. Spine J 13 : 22-31, 2013   DOI
25 Lee JH, Lee KM, Baek HR, Jang SJ, Lee JH, Ryu HS : Combined effects of porous hydroxyapatite and demineralized bone matrix on bone induction : in vitro and in vivo study using a nude rat model. Biomed Mater 6 : 015008, 2011   DOI
26 Lee KJ, Roper JG, Wang JC : Demineralized bone matrix and spinal arthrodesis. Spine J 5 (6 Suppl) : 217S-223S, 2005   DOI