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KMID : 0922220130130020065
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Journal of the Korean Musculoskeletal Transplantation Society
2013 Volume.13 No. 2 p.65 ~ p.73
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The Results of One level Posterolateral Fusion Using Porous Hydroxyapatite/Local Autogenous Bone Graft Compared with Iliac Crest Autogenous Bone Graft in Lumbar Degenerative Disease
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Park Jung-Woo
Park Jun-Yeong
Lee Seung-Hyun
Song Ho-Sup
Yang Jun-Young
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Abstract
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Purpose: A prospective, randomized study comparing autogenous iliac crest bone graft to porous hydroxyapatite with local autograft in instrumented posterolateral one-level fusions for lumbar degenerative disease
Materials and methods: To determine clinical outcomes and fusion rates of instrumented onelevel posterolateral fusions using autogenous iliac crest bone graft or porous hydroxyapatite, an artificial bone substitute, combined with lamina autograft(50:50 mix) were evaluated. To the best of our knowledge a human pilot study using porous hydroxyapatite with local autograft has not been previously investigated. Demographic and perioperative data, Oswestry Low Back Pain Disability Index, and leg and back pain scores were determined before surgery, and 1, 3, 6, 12, 24 and 36 months after surgery. Independent radiologist and two spine surgeons evaluate the simple radiographs that were obtained at postoperative 6, 12, 24, and 36 months according to the Lenke’s criteria.
Results: There were 67 subjects, 30 in the autogenous iliac crest bone graft group (A) and 37 in the porous hydroxyapatite with local autograft group (B). There were no significant differences for age, weight, sex, smoking, worker’s compensation between the groups. The average operative times were 2.9 hours and 2.4 hours respectively and blood loss were 465 cc in group A and 273 cc in group B. There were no significant differences in any outcome measure at all time intervals. In group A, the fusion grade A was 73.3%, B was 13.3%, C was 6.7% and D was 6.7%. In group B, the fusion grade A was 67.6%, B was 16.2%, and C was 10.8% and D was 5.4%. Fusion rates were not significantly different between both groups (p>0.05).
Conclusion: The fusion rate in the iliac bone group was similar with the porous hydroxyapatite and local autograft group. There was significant improvement of Oswestry Low Back Pain Disability Index, and leg and back pain scores in both groups over all time intervals and surgical time and blood loss were significantly less in the porous hydroxyapatite with local autograft.
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KEYWORD
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Porous hydroxyapatite, Lumbar fusion, Autogenous iliac crest bone, Autogenous local bone
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