Hydroxyapatite/collagen composite graft for posterior lumbar interbody fusion: a comparison with local bone graft
Abstract Background Autologous bone has been used for posterior lumbar intervertebral fusion (PLIF). However, harvesting autologous bone graft is associated with donor site complications. We previously developed a hydroxyapatite/collagen (HAp/Col) composite as an osteoconductive artificial bone, cha...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-10-01
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| Series: | Journal of Orthopaedic Surgery and Research |
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| Online Access: | https://doi.org/10.1186/s13018-021-02798-4 |
| _version_ | 1797999489100808192 |
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| author | Toshitaka Yoshii Motonori Hashimoto Satoru Egawa Takashi Hirai Hiroyuki Inose Atsushi Okawa |
| author_facet | Toshitaka Yoshii Motonori Hashimoto Satoru Egawa Takashi Hirai Hiroyuki Inose Atsushi Okawa |
| author_sort | Toshitaka Yoshii |
| collection | DOAJ |
| description | Abstract Background Autologous bone has been used for posterior lumbar intervertebral fusion (PLIF). However, harvesting autologous bone graft is associated with donor site complications. We previously developed a hydroxyapatite/collagen (HAp/Col) composite as an osteoconductive artificial bone, characterized by having a highly porous structure with sponge‐like elasticity. This study aims to investigate the effectiveness of HAp/Col composite with bone marrow aspirate (BMA) as a graft substitute in PLIF for the treatment of lumbar spinal diseases. Methods This study prospectively investigated patients who received one-level PLIF. For the interbody fusion, two titanium cages were inserted. On the one side of interbody space, HAp/Col composite incorporated with BMA filling the titanium cage was grafted. On the other side, local bone graft (LBG) harvested during decompressive laminotomy was grafted and then one-level instrumentation using pedicle screws was performed. The target levels were at L2/3 in 2 cases, L3/4 in 3 cases, L4/5 in 36 cases, and L5/S in 5 cases. We evaluated clinical symptoms and radiological outcomes of 46 patients and compared the fusion status of HAp/Col composite with that of LBG. Results The 1-year postoperative CT evaluation demonstrated that, in the HAp/Col, a complete fusion was observed in 38 patients (82.6%), whereas in the LBG, a complete fusion was observed in 35 patients (76.1%). There were no statistical differences between the HAp/Col and LBG. In the HAp/Col, incomplete fusion was observed in five patients (10.9%) and non-fusion in two patients (4.3%), and in the LBG, incomplete fusion was observed in nine patients (19.6%) and non-fusion in two patients (4.3%). At 2 years after the surgery, complete fusion increased to 44 patients (95.7%) in the HAp/Col and 41 patients (89.1%) in the LBG. There were no significant differences in the clinical scores for lumbar spine between patients with fusion and non-fusion. Conclusions The HAp/Col composite with BMA in the titanium cage can be effectively used as an alternative to conventional autologous LBG for intervertebral spinal fusion. Trial registration University hospital Medical Information Network, UMIN000045010, July 30th, 2021, Retrospectively registered, https://www.umin.ac.jp/english/ . |
| first_indexed | 2024-04-11T11:05:31Z |
| format | Article |
| id | doaj.art-a69abc528fcb41eebf704003624859c3 |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-04-11T11:05:31Z |
| publishDate | 2021-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-a69abc528fcb41eebf704003624859c32022-12-22T04:28:22ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2021-10-011611810.1186/s13018-021-02798-4Hydroxyapatite/collagen composite graft for posterior lumbar interbody fusion: a comparison with local bone graftToshitaka Yoshii0Motonori Hashimoto1Satoru Egawa2Takashi Hirai3Hiroyuki Inose4Atsushi Okawa5Department of Orthopedic Surgery, Tokyo Medical and Dental UniversityDepartment of Orthopedic Surgery, Tokyo Medical and Dental UniversityDepartment of Orthopedic Surgery, Tokyo Medical and Dental UniversityDepartment of Orthopedic Surgery, Tokyo Medical and Dental UniversityDepartment of Orthopedic Surgery, Tokyo Medical and Dental UniversityDepartment of Orthopedic Surgery, Tokyo Medical and Dental UniversityAbstract Background Autologous bone has been used for posterior lumbar intervertebral fusion (PLIF). However, harvesting autologous bone graft is associated with donor site complications. We previously developed a hydroxyapatite/collagen (HAp/Col) composite as an osteoconductive artificial bone, characterized by having a highly porous structure with sponge‐like elasticity. This study aims to investigate the effectiveness of HAp/Col composite with bone marrow aspirate (BMA) as a graft substitute in PLIF for the treatment of lumbar spinal diseases. Methods This study prospectively investigated patients who received one-level PLIF. For the interbody fusion, two titanium cages were inserted. On the one side of interbody space, HAp/Col composite incorporated with BMA filling the titanium cage was grafted. On the other side, local bone graft (LBG) harvested during decompressive laminotomy was grafted and then one-level instrumentation using pedicle screws was performed. The target levels were at L2/3 in 2 cases, L3/4 in 3 cases, L4/5 in 36 cases, and L5/S in 5 cases. We evaluated clinical symptoms and radiological outcomes of 46 patients and compared the fusion status of HAp/Col composite with that of LBG. Results The 1-year postoperative CT evaluation demonstrated that, in the HAp/Col, a complete fusion was observed in 38 patients (82.6%), whereas in the LBG, a complete fusion was observed in 35 patients (76.1%). There were no statistical differences between the HAp/Col and LBG. In the HAp/Col, incomplete fusion was observed in five patients (10.9%) and non-fusion in two patients (4.3%), and in the LBG, incomplete fusion was observed in nine patients (19.6%) and non-fusion in two patients (4.3%). At 2 years after the surgery, complete fusion increased to 44 patients (95.7%) in the HAp/Col and 41 patients (89.1%) in the LBG. There were no significant differences in the clinical scores for lumbar spine between patients with fusion and non-fusion. Conclusions The HAp/Col composite with BMA in the titanium cage can be effectively used as an alternative to conventional autologous LBG for intervertebral spinal fusion. Trial registration University hospital Medical Information Network, UMIN000045010, July 30th, 2021, Retrospectively registered, https://www.umin.ac.jp/english/ .https://doi.org/10.1186/s13018-021-02798-4Graft substituteHydroxyapatite with collagenLocal bone graftPosterior lumbar interbody fusionFusion rate |
| spellingShingle | Toshitaka Yoshii Motonori Hashimoto Satoru Egawa Takashi Hirai Hiroyuki Inose Atsushi Okawa Hydroxyapatite/collagen composite graft for posterior lumbar interbody fusion: a comparison with local bone graft Journal of Orthopaedic Surgery and Research Graft substitute Hydroxyapatite with collagen Local bone graft Posterior lumbar interbody fusion Fusion rate |
| title | Hydroxyapatite/collagen composite graft for posterior lumbar interbody fusion: a comparison with local bone graft |
| title_full | Hydroxyapatite/collagen composite graft for posterior lumbar interbody fusion: a comparison with local bone graft |
| title_fullStr | Hydroxyapatite/collagen composite graft for posterior lumbar interbody fusion: a comparison with local bone graft |
| title_full_unstemmed | Hydroxyapatite/collagen composite graft for posterior lumbar interbody fusion: a comparison with local bone graft |
| title_short | Hydroxyapatite/collagen composite graft for posterior lumbar interbody fusion: a comparison with local bone graft |
| title_sort | hydroxyapatite collagen composite graft for posterior lumbar interbody fusion a comparison with local bone graft |
| topic | Graft substitute Hydroxyapatite with collagen Local bone graft Posterior lumbar interbody fusion Fusion rate |
| url | https://doi.org/10.1186/s13018-021-02798-4 |
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