Beta tricalcium phosphate: observation of use in 100 posterolateral lumbar instrumented fusions.
BACKGROUND
Beta tricalcium phosphate (B-TCP) is increasingly used to supplement lamina autograft to perform posterolateral lumbar-instrumented arthrodesis.


OBJECTIVE
To determine the radiographic arthrodesis and pseudarthrosis rates after multisegment lumbar laminectomies and one- or two-segment posterolateral instrumented fusion using lamina autograft and an artificial bone graft expander B-TCP (Vitoss; Orthovita, Malvern, PA, USA).


METHODS
To document radiographic arthrodesis/pseudarthrosis rates using lamina autograft and B-TCP.


METHODS
One hundred patients with lumbar spinal stenosis underwent multisegment laminectomies (average 3.6 segments) and one- (78 patients) or two- (22 patients) segment posterolateral instrumented arthrodesis.


METHODS
Two-year postoperative outcomes were assessed using Short-Form 36 questionnaires.


METHODS
The arthrodesis mass consisted of lamina autograft and B-TCP. Two independent neuroradiologists, using both dynamic X-rays and 2D-CT studies performed 3, 4.5, 6, and up to 12 months postoperatively, documented radiographic arthrodesis progression.


RESULTS
One-segment arthrodesis was performed in 79 patients; 74 (93.7%) were radiographically fused "early" (6.5 postoperative months), 2 (2.5%) fused "late" (6.5-12 months), and 3 (3.8%) exhibited pseudarthrosis. Two-segment arthrodesis was performed in 21 patients; 14 (66.7%) radiographically fused "early," 5 (23.8%) fused "late," and 2 (9.5%) exhibited pseudarthrosis. Although chi-square analyses revealed a significant increase in the number of "late" radiographic fusions occurring for patients undergoing two-level arthrodesis, no significant difference in radiographic pseudarthrosis rates was noted between the two patient populations. In both groups, Short-Form 36 questionnaires revealed nearly comparable maximal improvement on seven of eight Health Scales by the second postoperative year.


CONCLUSIONS
At 6.5 months after multisegment lumbar laminectomies with posterolateral instrumented lumbar arthrodesis using lamina autograft/B-TCP, more one-segment (93.7%) versus two-segment (66.7%) radiographic arthrodesis occurred. By 1 year after operation, there was no significant difference in fusion rates between one- and two-segment radiographic arthrodeses.
Epstein
Nancy E
NE
Neurological Surgery, the Albert Einstein College of Medicine, Bronx, NY, USA. dch3@columbia.edu
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001672:Biocompatible Materials / Q000627:therapeutic use*; D002130:Calcium Phosphates / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011542:Pseudarthrosis / Q000453:epidemiology; D013123:Spinal Fusion / Q000379:methods*; D013130:Spinal Stenosis / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014182:Transplantation, Autologous
D001672:Biocompatible Materials; D002130:Calcium Phosphates; C485817:beta-tricalcium phosphate