Lumbar posterolateral fusion with biphasic calcium phosphate ceramic.
The authors conducted a retrospective observational study of patients who needed lumbar posterolateral fusion (PLF) using a biphasic calcium phosphate ceramic implant as a substitute for bone graft. The findings of clinical, radiographic, and histologic examinations were reviewed. Thirty-two patients underwent single-level PLF with instrumentation. In all cases, to decrease the occurrence of donor-site complications and morbidity, locally harvested morselized bone from the decompressive site was mixed with hydroxyapatite and beta-tricalcium phosphate (HAP-TCP) granules and sticks and used for fusion at the posterolateral aspect of the lumbar spine. The histologic findings of three biopsy specimens obtained during second operations for metallic implant removal were reviewed. The minimum follow-up period was 26 months. There was no evidence of instrument loosening or breakage. However, bone-graft incorporation was difficult to evaluate radiographically, because image quality was inferior to that with conventional autogenous iliac bone graft. Partial graft bone resorption was revealed on radiographs in 75% of cases. The results showed clinical improvement in all but one case. Solid fusion was observed during the second operation in all three cases. Histologic analysis showed excellent bone incorporation around the HAP-TCP granules. These findings suggest that, although the bulk of the fusion mass with HAP-TCP was smaller than that with autogenous bone, this technique combined with rigid instrumentation is a safe and effective procedure.
Fujibayashi
S
S
Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-9507, Japan. shfuji@kuhp.kyoto-u.ac.jp
Shikata
J
J
Tanaka
C
C
Matsushita
M
M
Nakamura
T
T
D000328:Adult; D000368:Aged; D002130:Calcium Phosphates / Q000627:therapeutic use*; D002516:Ceramics / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009984:Orthopedic Fixation Devices; D011183:Postoperative Complications; D011859:Radiography; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome
D002130:Calcium Phosphates; C485828:alpha-tricalcium phosphate; C485830:tetracalcium phosphate; C485838:calcium phosphate, monobasic, anhydrous; C020243:calcium phosphate; C485829:calcium phosphate, dibasic, anhydrous