Coralline hydroxyapatite and laminectomy-derived bone as adjuvant graft material for lumbar posterolateral fusion.
OBJECTIVE
The purpose of this study was to evaluate the effectiveness of coralline hydroxyapatite (CHA) and laminectomy-derived bone as an adjuvant graft material when combined with autogenous iliac bone graft (AIBG) in posterolateral fusion (PLF).


METHODS
This prospective, case-control study involved 58 patients who underwent lumbar instrumentation-augmented PLF for degenerative spinal stenosis-induced segmental instability between July 2000 and June 2001. The patients were divided into three groups. Laminectomy bone and AIBG were placed in the right intertransverse process space in Group 1 (20 patients), CHA and AIBG were placed in Group 2 (19 patients), and laminectomy bone and CHA were placed in Group 3 (19 patients). Pure autogenous iliac cancellous bone graft was placed in the left intertransverse process space in all three groups of patients. Successful fusion was determined by two spine surgeons after examining the plain, anteroposterior, bilateral oblique, and lateral flexion-extension radiographs. If the examiners did not agree on fusion status, fine-cut computerized tomography scans of the fusion mass were used to make the final decision. The chi-square test was used to compare the fusion rate at different time intervals among the three groups.


CONCLUSIONS
Pure AIBG placed in left intertransverse process space was associated with the best fusion rate. After 6 months, CHA produced a comparable result to laminectomy-derived bone when combined with AIBG. When laminectomy bone was mixed with CHA, the combination failed to yield a satisfactory fusion rate (57.9%) even 1 year after surgery if no AIBG was added.
Hsu
Chien-Jen
CJ
Department of Orthopedics, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan. cjhsu@isca.vghks.gov.tw
Chou
Wen-Ying
WY
Teng
Hsiu-Peng
HP
Chang
Wei-Ning
WN
Chou
Yi-Jiun
YJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018786:Bone Substitutes; D016025:Bone Transplantation; D016022:Case-Control Studies; D002516:Ceramics / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006882:Hydroxyapatites / Q000627:therapeutic use*; D007796:Laminectomy; D008297:Male; D008422:Materials Testing; D008875:Middle Aged; D013123:Spinal Fusion / Q000295:instrumentation*; D013130:Spinal Stenosis / Q000601:surgery*; D016896:Treatment Outcome
D018786:Bone Substitutes; D006882:Hydroxyapatites; C119955:coralline hydroxyapatite