Surgical outcomes of two kinds of demineralized bone matrix putties/local autograft composites in instrumented posterolateral lumbar fusion

Abstract

Background 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). Methods Twenty-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. Results At 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. Conclusions Our 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.

The impact of demineralized bone matrix characteristics on pseudarthrosis and surgical outcomes after posterolateral lumbar decompression and fusion

“…[ 22 ] However, subsequent studies have reached conflicting conclusions on the advantages of bone fibers and various carrier materials in DBM for promoting osteoinduction and bone fusion. [ 9 10 11 12 14 15 ] Our retrospective cohort study examined three different DBM formulations but found no differences in fusion rates when comparing carrier type, bone fibers, and carrier presence.…”

“…They demonstrated that the fusion rates of posterolateral lumbar fusion surgery were not significantly different between hyaluronate (66.7%) and glycerol (70.4%) DBM carriers ( P = 0.574). [ 10 ] On the contrary, in an animal model of 18 rats per group, Peterson et al . demonstrated that the glycerol DBM carrier showed higher fusion rates than the hyaluronate-containing DBM carrier.…”

“…However, there is disagreement in the literature about the impact of carrier substances on bone formation, and there is a lack of literature directly comparing outcomes of spine surgery with hyaluronate-containing DBM, glycerol-containing DBM, and DBM absent of a carrier. [ 7 8 9 10 ] In addition, some authors have suggested the potential of fiber-containing allografts for generating osteoinduction. [ 11 12 ] Although a recent meta-analysis demonstrated that the use of DBM plus autograft in spinal fusion was associated with higher fusion rates than autograft alone, clinical studies comparing successful spinal fusion rates using grafts with sodium hyaluronate versus glycerol carriers have dissenting conclusions, necessitating further investigation to determine the efficacy of synthetic graft on successful fusion.…”

Demineralized cortical fibers are associated with a low pseudarthrosis rate in patients undergoing surgery for adult spinal deformity without three-column osteotomy

“…Pseudarthrosis on a radiographic scan is not necessarily symptomatic and does therefore not always necessitate further intervention as discussed previously. Vice versa, successful fusion does not always lead to satisfactory clinical outcomes ( Chang et al., 2021 ; Fischgrund et al., 1997 ; Herkowitz and Kurz, 1991 ). The outcome for this study was therefore defined as an outcome with definite clinical impact, i.e.…”