title: Clinical outcomes and fusion rates following anterior lumbar interbody fusion with bone graft substitute i-FACTOR, an anorganic bone matrix/P-15 composite.
abstract: OBJECTIVE
  Despite limited availability and the morbidity associated with autologous iliac crest bone graft (ICBG), its use in anterior lumbar interbody fusion (ALIF) procedures remains the gold standard to achieve arthrodesis. The search for alternative grafts yielding comparable or superior fusion outcomes with fewer complications continues. In particular, i-FACTOR, a novel bone graft substitute composed of anorganic bone matrix (ABM) with P-15 small peptide, is one example currently used widely in the dental community. Although preclinical studies have documented its usefulness, the role of i-FACTOR in ALIF procedures remains unknown. The authors' goal was to determine the safety and efficacy of i-FACTOR bone graft composite used in patients who underwent ALIF by evaluating fusion rates and clinical outcomes.
  
  
  METHODS
  A nonblinded cohort of patients who were all referred to a single surgeon's practice was prospectively studied. One hundred ten patients with degenerative spinal disease underwent single or multilevel ALIF using the ABM/P-15 bone graft composite with a mean of 24 months (minimum 15 months) of follow-up were enrolled in the study. Patient's clinical outcomes were assessed using the Oswestry Disability Index for low-back pain, the 12-Item Short Form Health Survey, Odom's criteria, and a visual analog scale for pain. Fine-cut CT scans were used to evaluate the progression to fusion.
  
  
  RESULTS
  All patients who received i-FACTOR demonstrated radiographic evidence of bony induction and early incorporation of bone graft. At a mean of 24 months of follow-up (range 15-43 months), 97.5%, 81%, and 100% of patients, respectively, who had undergone single-, double-, and triple-level surgery exhibited fusion at all treated levels. The clinical outcomes demonstrated a statistically significant (p < 0.05) difference between preoperative and postoperative Oswestry Disability Index, 12-Item Short Form Health Survey, and visual analog scores.
  
  
  CONCLUSIONS
  The use of i-FACTOR bone graft substitute demonstrates promising results for facilitating successful fusion and improving clinical outcomes in patients who undergo ALIF surgery for degenerative spinal pathologies.
authors.affiliation: NeuroSpineClinic, Prince of Wales Private Hospital; and.
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Mobbs
authors.forename: Monish
authors.initials: M
authors.lastname: Maharaj
authors.forename: Prashanth J
authors.initials: PJ
authors.lastname: Rao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001857:Bone Matrix; D018786:Bone Substitutes / Q000008:administration & dosage* / Q000009:adverse effects; D003094:Collagen / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017116:Low Back Pain / Q000000981:diagnostic imaging / Q000601:surgery; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D011843:Radiculopathy / Q000000981:diagnostic imaging / Q000601:surgery; D011859:Radiography; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D018786:Bone Substitutes; D010446:Peptide Fragments; C407062:cell-binding peptide P-15; D003094:Collagen
keywords: ABM = anorganic bone matrix; ABM/P-15; ALIF = anterior lumbar interbody fusion; BMP = bone morphogenetic protein; DDD = degenerative disc disease; ICBG = iliac crest bone graft; ODI = Oswestry Disability Index; SF-12 = 12-Item Short Form Health Survey; VAS = visual analog scale; anterior lumbar interbody fusion; bone graft substitute; degenerative disc disease; i-FACTOR; rhBMP = recombinant human BMP