Anterior lumbar interbody fusion with processed sea coral (coralline hydroxyapatite) as part of a circumferential fusion.
METHODS
A retrospective review of 20 patients undergoing circumferential lumbar fusion with coralline hydroxyapatite blocks anteriorly and autograft with transpedicular or translaminar facet screw fixation posteriorly.


OBJECTIVE
To examine the efficacy of coralline hydroxyapatite as a bone graft substitute for anterior lumbar interbody fusion.


BACKGROUND
Autograft is the gold standard for bone grafting in the anterior lumbar spine. Harvesting bone from the iliac crest leads to significant postoperative pain and morbidity. Femoral ring allograft is a widely used alternative to autograft but has some inherent problems. Coralline hydroxyapatite was shown to be 100% successful for anterior cervical fusion when combined with rigid plating.


METHODS
A retrospective review of 20 patients with low back pain and indicated for surgical intervention. A circumferential instrumented fusion was performed with coralline hydroxyapatite blocks anteriorly and transpedicular or translaminar facet fixation and autograft posteriorly. All patients reached a minimum 3-year clinical and radiologic follow-up.


RESULTS
Radiographic follow-up yielded a solid arthrodesis rate of 93.8% by level (30 of 32 disc spaces) and 90% by patient (18 of 20). Clinical follow-up generated a mean pain reduction of 61.8% with clinical success demonstrated in 80% (16 of 20) of all patients who reported good or excellent pain relief. Eight of 12 (66.7%) patients employed before surgery returned to work in some capacity.


CONCLUSIONS
Coralline hydroxyapatite is a practicable anterior lumbar interbody fusion alternative to autograft and allograft as part of a circumferential fusion with rigid posterior fixation. It is not recommended for stand-alone anterior lumbar interbody fusion without further study.
Thalgott
John S
JS
International Spinal Development & Research Foundation, Las Vegas, NV 89106, USA. spine@spine-research.org
Klezl
Zendek
Z
Timlin
Marcus
M
Giuffre
James M
JM
D000328:Adult; D000368:Aged; D016025:Bone Transplantation; D002516:Ceramics / Q000737:chemistry / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006882:Hydroxyapatites / Q000737:chemistry / Q000627:therapeutic use*; D007403:Intervertebral Disc / Q000000981:diagnostic imaging / Q000601:surgery; D017116:Low Back Pain / Q000209:etiology / Q000628:therapy; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016062:Porosity; D011859:Radiography; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome
D006882:Hydroxyapatites; C119955:coralline hydroxyapatite