scholarly journals Repeated Ct-based Hounsfield Unit Measurements as a Proxy Measure of Intercorporal Bone Graft Remodelling Towards Spinal Fusion; a Feasibility Study.

2022 ◽  
Author(s):  
JFH Reijmer ◽  
LD Jong ◽  
M. C. Kruyt ◽  
MJ van Gorp ◽  
JLC van Susante
Keyword(s):  
Bone Graft ◽  
Spinal Fusion ◽  
Lumbar Fusion ◽  
Intraobserver Reliability ◽  
Mineral Density ◽  
Fusion Surgery ◽  
Measuring Procedure ◽  
Proxy Measure ◽  
Graft Remodelling ◽  
Over Time

Abstract Background: There is a lack of knowledge about the biological process of intercorporal bone graft remodelling towards successful lumbar spine fusion with bridging vital bone between two adjacent vertebrae. Hounsfield Units (HU) highly correlate with Bone Mineral Density (BMD) and changes in HU may be valuable as proxy measure to monitor ongoing fusion. The aims of this study were to explore the feasibility to quantify BMD changes in the intercorporal bone graft after spinal fusion on consecutive CT-scans, and to explore whether trends in the individual changes in HU over time may serve as a proxy measure for successful fusion or non-fusion.Methods: A retrospective case series was conducted using available one-year and two-year CT-data from patients after posterior lumbar interbody fusion surgery. First, a standardized measuring procedure was developed, incorporating internal phantomless calibration, to establish the HU values of the grafted region of interest using consecutive CT-slices. Subsequently, changes in the participants’ bone graft HU over time between their first and second year after surgery were explored.Results: Between one and two years after surgery, seven out of nine (78%) participants showed an increase in their bone grafts’ HU, ranging from 3% to 41%. In two participants HU-values decreased 14% and 32%, respectively. The intraobserver reliability of the HU measuring procedure was excellent (ICC 0.93 (95% confidence interval 0.91 to 0.95)).Conclusion: The majority (78%) of participants in the current study showed increases in their bone graft HU, which suggests ongoing bone graft remodelling towards lumbar fusion. This result corresponds with the established percentages of achieved rigid bony fusion after lumbar spinal fusion surgery reported in the literature. Thus, prospective follow-up of CT-based HU measurements may have potential as diagnostic measure to monitor bone graft remodelling in time and trends may predict successful fusion or non-fusion. The measurement procedure developed in this study, using internal phantomless calibration, showed excellent intraobserver reliability and merits further study in larger patient numbers.

scholarly journals An inception cohort study of patients in a military clinic treated for lower back pain with lumbar fusion and SIGNAFUSE® with a systematic review of the literature

2018 ◽  
Author(s):  
Grant Steen
Keyword(s):  
Systematic Review ◽  
Bone Graft ◽  
Spinal Fusion ◽  
Lumbar Fusion ◽  
Fusion Rate ◽  
Fusion Surgery ◽  
Synthetic Bone ◽  
Synthetic Bone Graft ◽  
Spinal Fusion Surgery ◽  
Bone Graft Substitutes

Background: Use of synthetic bone graft substitutes for spinal fusion has increased sharply over the past 20 years. SIGNAFUSE® is one such synthetic graft material that provides an osteostimulatory effect for spinal fusion. Because clinical trials are not required for commercialization of synthetic bone graft substitutes in the United States, fusion rates attained using SIGNAFUSE for lumbar fusion are not well documented. The goal of the current study is to determine the rate of spinal fusion in a military clinic following lumbar fusion surgery augmented with SIGNAFUSE. Methods: We report a retrospective chart review of 8 patients who received lumbar spinal fusion surgery augmented with SIGNAFUSE. All patients were assessed by computed tomographic (CT) imaging at least 1-year post-surgery to determine whether bony fusion had occurred. We also systematically reviewed literature sources that report fusion rate following spinal fusion surgery, for broader context. Results: An average of 1.6 spinal levels were treated with SIGNAFUSE-loaded interbody cages. All patients had stabilization hardware via pedicle screws or integrated cage fixation. Seven of 8 patients successfully fused, for an overall fusion rate of 87.5% (95% confidence interval: 47.4% to 99.7%). Systematic review of 26 recent publications that included 1,126 patients treated with synthetic bone graft showed that the overall fusion rate in the literature is 84.4%. Conclusions: Fusion was achieved in 87.5% of patients treated with SIGNAFUSE. This is comparable to the fusion rate in a systematic review of 1,126 patients treated with synthetic bone graft materials.

A retrospective study of iliac crest bone grafting techniques with allograft reconstruction: do patients even know which iliac crest was harvested?

2014 ◽  
Vol 21 (4) ◽  
pp. 595-600 ◽  
Author(s):  
Stephen M. Pirris ◽  
Eric W. Nottmeier ◽  
Sherri Kimes ◽  
Michael O'Brien ◽  
Gazanfar Rahmathulla
Keyword(s):  
Bone Graft ◽  
Iliac Crest ◽  
Lumbar Fusion ◽  
Skin Incision ◽  
Bony Defect ◽  
Graft Material ◽  
Fusion Surgery ◽  
Allograft Reconstruction ◽  
Lumbar Fusion Surgery ◽  
Site Pain

Object Considerable biological research has been performed to aid bone healing in conjunction with lumbar fusion surgery. Iliac crest autograft is often considered the gold standard because it has the vital properties of being osteoconductive, osteoinductive, and osteogenic. However, graft site pain has been widely reported as the most common donor site morbidity. Autograft site pain has led many companies to develop an abundance of bone graft extenders, which have limited proof of efficacy. During the surgical consent process, many patients ask surgeons to avoid harvesting autograft because of the reported pain complications. The authors sought to study postoperative graft site pain by simply asking patients whether they knew which iliac crest was grafted when a single skin incision was made for the fusion operation. Methods Twenty-five patients underwent iliac crest autografting with allograft reconstruction during instrumented lumbar fusion surgery. In all patients the autograft was harvested through the same skin incision but with a separate fascial incision. At various points postoperatively, the patients were asked if they could tell which iliac crest had been harvested, and if so, how much pain did it cause (10-point Numeric Rating Scale). Results Most patients (64%) could not correctly determine which iliac crest had been harvested. Of the 9 patients who correctly identified the side of the autograft, 7 were only able to guess. The 2 patients who confidently identified the side of grafting had no pain at rest and mild pain with activity. One patient who incorrectly guessed the side of autografting did have significant sacroiliac joint degenerative pain bilaterally. Conclusions Results of this study indicate the inability of patients to clearly define their graft site after iliac crest autograft harvest with allograft reconstruction of the bony defect unless they have a separate skin incision. This simple, easily reproducible pilot study can be expanded into a larger, multiinstitutional investigation to provide more definitive answers regarding the ideal, safe, and cost-effective bone graft material to be used in spinal fusions.

Bone graft alternatives in spinal fusion surgery

2003 ◽  
Vol 14 (3) ◽  
pp. 127-137 ◽  
Author(s):  
David H. Kim ◽  
Louis Jenis ◽  
Scott C. Berta ◽  
Alexander R. Vaccaro
Keyword(s):  
Bone Graft ◽  
Spinal Fusion ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery

scholarly journals PROPHYLAXIS OF SURGICAL SITE INFECTION WITH VANCOMYCIN IN 513 PATIENTS THAT UNDERWENT TO LUMBAR FUSION

2015 ◽  
Vol 14 (3) ◽  
pp. 177-180 ◽  
Author(s):  
Nicolas Scheverin ◽  
Alejandro Steverlynck ◽  
Roberto Castelli ◽  
Diego Sobrero ◽  
Nicolas Videla Kopp ◽  
...  
Keyword(s):  
Bone Graft ◽  
Spinal Fusion ◽  
Statistical Difference ◽  
Lumbar Fusion ◽  
Posterior Spinal Fusion ◽  
Control Group ◽  
Site Infection ◽  
Intravenous Antibiotic ◽  
Skin Preparation ◽  
Vancomycin Group

Objective:To assess the prophylactic effects of local vancomycin on an infection of the surgical site in patients undergoing lumbar instrumented fusion.Methods:Retrospective study from January 2011 to June 2014 in patients with symptomatic and refractory lumbar spine stenosis and listhesis who underwent instrumented pedicle screw spinal fusion. Two groups of patient were analyzed, one using vancomycin on the surgical site, vancomycin group (VG) and the control group (CG) without topical vancomycin. The routine prophylactic procedures were performed in both groups: aseptic scrub technique, skin preparation, preoperative intravenous antibiotic therapy. The VG received a dose of 1g of vancomycin mixed with the bone graft every three spinal levels fused and the group consisted of 232 patients.Results:513 patients were analyzed, 232 in the VG and 281 in the CG. There was no statistical difference between the groups when the sex, mean surgery length, and mean bleeding volume were considered. The rate of infection for VG was reduced from 4.98% to 1.29% when compared with CG.Conclusion:The use of vancomycin added to the bone graft in posterior spinal fusion is associated with significantly lower rates of infection.

Bone Mineral Density After Spinal Fusion Surgery for Adolescent Idiopathic Scoliosis at a Minimum 20-Year Follow-up

2018 ◽  
Vol 6 (2) ◽  
pp. 170-176 ◽  
Author(s):  
Masayuki Ohashi ◽  
Toru Hirano ◽  
Kei Watanabe ◽  
Keiichi Katsumi ◽  
Hirokazu Shoji ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Spinal Fusion ◽  
Bone Mineral ◽  
Mineral Density ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery
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