Clinical and radiographic outcomes of extreme lateral approach to interbody fusion with β-tricalcium phosphate and hydroxyapatite composite for lumbar degenerative conditions

Abstract

BackgroundHistorically, iliac crest bone graft has been used as the graft of choice for lumbar spine fusion procedures. Because fusion techniques have become less invasive, the demand for minimally disruptive grafting options has increased. This prospective study was performed to assess clinical and radiographic outcomes of patients treated with an iliac crest bone graft alternative and lateral lumbar interbody fusion.MethodsFifty degenerative lumbar patients were treated with the extreme lateral approach to interbody fusion and a β-tricalcium phosphate–hydroxyapatite graft with bone marrow aspirate (BMA) at 1 or 2 adjacent levels. BMA was collected from the iliac crest with a bone aspiration needle and applied to the FormaGraft (NuVasive, Inc., San Diego, California) in a 1:1 ratio. Radiolucent cages were filled with FormaGraft strips, granules, or blocks and implanted in a standard fashion. Clinical data were collected at baseline, 6 weeks, and 3, 6, and 12 months and included visual analog scale, Oswestry Disability Index, and Short Form 36 patient-reported assessments. Fusion assessments were made from neutral anteroposterior/lateral radiographs, lateral flexion/extension radiographs, and computed tomography images taken at least 12 months after surgery.ResultsForty-four patients treated at 49 levels completed follow-up. The mean patient age was 54.7 ± 10.8 years, and mean body mass index was 30.8 ± 7.7 kg/m2. Radiographic fusion was observed in 41 of 44 assessed levels (93.2%). Blood loss was less than 100 mL in 95.5% of patients. Of the patients, 93.2% spent 1 night or less in the hospital. By the 6-week follow-up, all clinical outcomes were significantly improved (P < .05). Improvements were maintained or increased throughout the course of follow-up.ConclusionsThis report shows that the technique of extreme lateral approach to interbody fusion in combination with FormaGraft and BMA in the interbody space is a safe and effective treatment option for interbody fusion of the lumbar spine when compared with other approaches and biologic options.

Role of oxidative metabolism in osseointegration during spinal fusion

“…At 12 months after spinal fusion surgery, the surgeon performed blinded analyses of spinal fusion success and graft osseointegration by radiographic assessment ( Fig 1A ). The radiograph was given a grade according to the Lenke scale, from A (well fused with remodeling and trabeculae present) to D (no fusion, resorption of bone graft) as summarized in Table 2 [ 46 ]. We then correlated the Lenke grade to patient age using the Spearman test.…”

“…At 12 months following spinal fusion surgery, the surgeon (AM), blinded to the results of the BMSC analyses, assessed spinal graft osseointegration by radiographic assessment. A Lenke grade of A–D was given for each patient ( Table 2 ) [ 46 ].…”

“…The Lenke classification is a widely used and accepted radiologic grading scale to evaluate posterolateral fusion success [45][46][47][48]. At 12 months following spinal fusion surgery, the surgeon (AM), blinded to the results of the BMSC analyses, assessed spinal graft osseointegration by radiographic assessment.…”

Percutaneous Injection of Autologous Bone Marrow Concentrate Cells Significantly Reduces Lumbar Discogenic Pain Through 12 Months

“…Reported ODI and VAS after lumbar spinal fusion 1 year after surgery vary considerably. Rodgers et al reported patients undergoing lateral lumbar interbody fusion with β‐tricalcium phosphate had initial ODI and VAS of 52 and 81, respectively, with improvements to 38 (ODI) and 50 (VAS) by 3 months, which was sustained through 12 months . A meta‐analysis of lumbar fusions using recombinant human bone morphogenetic protein 2 (rhBMP‐2) indicated no statistical improvement in pain scores over conservative care or iliac crest bone grafts, and an associated increase in the incidence of cancer .…”

Understanding the Future Prospects of Synergizing Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgery with Ceramics and Regenerative Cellular Therapies

“…Similarly, ultraporous TCP has been clinically observed as an effective bone void filler in spinal arthrodesis and can reduce morbidity [ 136 ]. The combined bone graft materials of β-TCP and HA with bone marrow aspirate have been found safe and efficacious in lateral interbody spinal fusion with significantly reduced blood loss [ 137 ]. It is important to note that an increase in the porosity of TCP improves wicking and hydrophilic properties resulting in an enhanced availability of nutrients, growth factors, and osteogenic cells.…”