Comparison of Fusion Rate and Functional Outcome Between Local Cancellous Bone Plus Demineralized Bone Matrix and Local Bone in 1-Level Posterior Lumbar Interbody Fusion

Abstract

Study Design: Retrospective study with prospectively collected data. Objective: The purpose of this study is to investigate the difference in fusion rate and clinical outcome of patients with local bone as filler for the graft and demineralized bone matrix (DBM) plus only the cancellous bone from local bone as a filler for cage in 1-level posterior lumbar interbody fusion (PLIF) with cage. Summary of Background Data: Cancellous bone is more advantageous than cortical bone in the local bone for improving bone formation in spine fusion surgery. There are little studies on the difference in fusion rate and reduction of fusion time using only these cancellous bones. Methods: Of the 40 patients who underwent 1-level PLIF using cage, 20 patients in group A used local bone and 20 patients in group B used mixture of cancellous bone extracted separately from local bone and commercially available DBM as filler for cage. Changes in fusion rate and intervertebral spacing were measured using lateral radiography, and fusion was determined as nonunion using the Brantigan-Steffee classification. The clinical outcome was evaluated. Results: There was no difference in height change over time between the two groups. Regarding union grade, group B showed better union grade than group A. However, no difference in union grade change over time was observed between the 2 groups. In group B, Oswestry Disability Index (ODI), Rolland-Morris Disability Questionnaire (RMDQ), and SF-36 mental component score (MCS) significantly decreased, but there was no difference in change over time. Conclusions: In 1-level PLIF for degenerative lumbar disease, better fusion rate was observed in the group that used only cancellous bone from local bone plus DBM than that in the group that used local bone; however, there was no difference in fusion grade change over time in the 2 groups.

Comparison of Fusion Rates among Various Demineralized Bone Matrices in Posterior Lumbar Interbody Fusion

“…The achievement of a fully solid fusion mass is crucial for the positive outcomes and success of lumbar interbody fusion surgery [13][14][15]. Previous literature indicates a radiologic fusion rate for PLIF ranging from 71% to 96% [11,16,17]. Autologous iliac bone graft is considered the gold standard for PLIF surgery [18], but it carries the risk of complications such as donor site morbidity.…”

“…In a canine study, the combination of DBM with autograft demonstrated faster spinal fusion compared to autograft alone, and in a rabbit interbody fusion model, a composite graft of DBM and hydroxyapatite block exhibited quicker and stronger fusion than autograft alone [9,10]. Furthermore, numerous human studies have demonstrated that the utilization of DBMs is an effective choice for bone union in PLIF surgery [11,12].…”

Demineralized Bone Matrix and Fibers in Spinal Fusion

“…The authors observed that older age and decreased bone density were associated with lower rates of fusion in both groups. Most recently, Ko et al 50 found that in 40 patients undergoing singlelevel PLIF (20 DBM and 20 local autograft), there was improvement in Brantigan-Steffee fusion scores in patients receiving DBM (4.4 DBM vs 3.7 local autograft, P = 0.001) but no difference in ODI between groups.…”

Numerical Assessment of Interspinous Spacers for Lumbar Spine

“…There are adverse effects beyond those expected because there may be postoperative complications since the commonly used procedures are very invasive [2]. Lumbar fusion has been the standard procedure for patients with lumbar disc wear that does not respond to conservative treatments, with excellent clinical results [12][13][14].…”