Hybrid Biosynthetic Autograft Extender for Use in Posterior Lumbar Interbody Fusion: Safety and Clinical Effectiveness

Autologous iliac crest bone graft is the preferred option for spinal fusion, but the morbidity associated with bone harvest and the need for graft augmentation in more demanding cases necessitates combining local bone with bone substitutes. The purpose of this study was to document the clinical effectiveness and safety of a novel hybrid biosynthetic scaffold material consisting of poly(D,L-lactide-co-glycolide) (PLGA, 75:25) combined by lyophilization with unmodified high molecular weight hyaluronic acid (10-12% wt:wt) as an extender for a broad range of spinal fusion procedures. We retrospectively evaluated all patients undergoing single- and multi-level posterior lumbar interbody fusion at an academic medical center over a 3-year period. A total of 108 patients underwent 109 procedures (245 individual vertebral levels). Patient-related outcomes included pain measured on a Visual Analog Scale. Radiographic outcomes were assessed at 6 weeks, 3-6 months, and 1 year postoperatively. Radiographic fusion or progression of fusion was documented in 221 of 236 index levels (93.6%) at a mean (±SD) time to fusion of 10.2+4.1 months. Single and multi-level fusions were not associated with significantly different success rates. Mean pain scores (+SD) for all patients improved from 6.8+2.5 at baseline to 3.6+2.9 at approximately 12 months. Improvements in VAS were greatest in patients undergoing one- or two-level fusion, with patients undergoing multi-level fusion demonstrating lesser but still statistically significant improvements. Overall, stable fusion was observed in 64.8% of vertebral levels; partial fusion was demonstrated in 28.8% of vertebral levels. Only 15 of 236 levels (6.4%) were non-fused at final follow-up

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Radiological and Clinical Comparison of 1 Cage versus 2 Cages for Posterior Lumbar Interbody Fusion with PEEK Cage and Local Bone Graft

Journal of Korean Society of Spine Surgery ◽

10.4184/jkss.2009.16.2.104 ◽

2009 ◽

Vol 16 (2) ◽

pp. 104

Author(s):

Deuk-Soo Jun ◽

Won-Ju Shin ◽

Kyung-Chan Lee

Keyword(s):

Bone Graft ◽

Interbody Fusion ◽

Posterior Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Peek Cage ◽

Clinical Comparison ◽

Local Bone

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Posterior Lumbar Interbody Fusion with Cage and Local Bone Graft in Spondylolisthesis - Unilateral-caged versus Bilateral-caged -

Journal of Korean Society of Spine Surgery ◽

10.4184/jkss.2008.15.2.73 ◽

2008 ◽

Vol 15 (2) ◽

pp. 73

Author(s):

Dong Ki Ahn ◽

Song Lee ◽

Dea Jung Choi ◽

Kwan Soo Kim ◽

Tae Woo Kim

Keyword(s):

Bone Graft ◽

Interbody Fusion ◽

Posterior Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Local Bone

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The efficacy of porous hydroxyapatite bone chip as an extender of local bone graft in posterior lumbar interbody fusion

European Spine Journal ◽

10.1007/s00586-011-2092-z ◽

2011 ◽

Vol 21 (7) ◽

pp. 1324-1330 ◽

Cited By ~ 15

Author(s):

Hyoungmin Kim ◽

Choon-Ki Lee ◽

Jin-Sup Yeom ◽

Jae-Hyup Lee ◽

Ki-Ho Lee ◽

...

Keyword(s):

Bone Graft ◽

Interbody Fusion ◽

Posterior Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Porous Hydroxyapatite ◽

Bone Chip ◽

Local Bone

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Incidence of microbiological contamination of local bone autograft used in posterior lumbar interbody fusion and its association with postoperative spinal infection

Journal of Neurosurgery Spine ◽

10.3171/2015.3.spine14578 ◽

2016 ◽

Vol 24 (1) ◽

pp. 20-24 ◽

Cited By ~ 3

Author(s):

Chong-Suh Lee ◽

Kyung-Chung Kang ◽

Sung-Soo Chung ◽

Ki-Tack Kim ◽

Seong-Kee Shin

Keyword(s):

Interbody Fusion ◽

Posterior Lumbar Interbody Fusion ◽

Positive Culture ◽

Spinal Infection ◽

Contamination Rate ◽

Lumbar Interbody Fusion ◽

Microbiological Culture ◽

Local Bone ◽

Bone Autograft ◽

Spinal Infections

OBJECT The aim of this study was to examine the results of microbiological cultures from local bone autografts used in posterior lumbar interbody fusion (PLIF) and to identify their association with postoperative spinal infection. METHODS The authors retrospectively evaluated cases involving 328 patients who had no previous spinal surgeries and underwent PLIF for degenerative diseases with a minimum 1-year follow-up. Local bone was obtained during laminectomy, and microbiological culture was performed immediately prior to bone grafting. The associations between culture results from local bone autografts and postoperative spinal infections were evaluated. RESULTS The contamination rate of local bone was 4.3% (14 of 328 cases). Coagulase-negative Staphylococcus (29%) was the most common contaminant isolated, followed by Streptococcus species and methicillin-sensitive Staphylococcus aureus. Of 14 patients with positive culture results, 5 (35.7%) had postoperative spinal infections and were treated with intravenous antibiotics for a minimum of 4 weeks. One of these 5 patients also underwent reoperation for debridement during this 4-week period. Regardless of the microbiological culture results, the infection rate after PLIF with local bone autograft was 2.4% (8 of 328 cases), with 5 (62.5%) of 8 patients showing positive results on autograft culture. CONCLUSIONS The incidence of contamination of local bone autograft during PLIF was considerable, and positive culture results were significantly associated with postoperative spinal infection. Special attention focused on the preparation of local bone for autograft and its microbiological culture will be helpful for the control of postoperative spinal infection.

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Effect of Trabecular Microstructure of Spinous Process on Spinal Fusion and Clinical Outcomes After Posterior Lumbar Interbody Fusion: Bone Surface/Total Volume as Independent Favorable Indicator for Fusion Success

World Neurosurgery ◽

10.1016/j.wneu.2019.12.115 ◽

2020 ◽

Vol 136 ◽

pp. e204-e213 ◽

Cited By ~ 1

Author(s):

Ping Liu ◽

Bin Zhou ◽

Fei Chen ◽

Zhehao Dai ◽

Yijun Kang

Keyword(s):

Spinal Fusion ◽

Clinical Outcomes ◽

Interbody Fusion ◽

Spinous Process ◽

Posterior Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Bone Surface ◽

Trabecular Microstructure

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Unilateral Transforaminal Lumbar Interbody Fusion: A Review of the Technique, Indications and Graft Materials

Journal of International Medical Research ◽

10.1177/147323000903700337 ◽

2009 ◽

Vol 37 (3) ◽

pp. 908-917 ◽

Cited By ~ 24

Author(s):

Y-X Xiao ◽

Q-X Chen ◽

F-C Li

Keyword(s):

Interbody Fusion ◽

Lumbar Disc ◽

Posterior Lumbar Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Disc Disease ◽

Discogenic Pain ◽

Fusion Procedure ◽

Local Bone ◽

Circumferential Fusion

Transforaminal lumbar interbody fusion (TLIF) is an alternative interbody fusion procedure in which interbody space is accessed via a path that runs through the far lateral portion of the vertebral foramen. TLIF reduces the potential complications of other approaches, including the transabdominal approach or posterior lumbar interbody fusion (PLIF), but still achieves clinical outcomes and circumferential fusion results comparable with PLIF. Operative indications for TLIF are contested among many spine experts. The optimal indications for using this technique are spondylolisthesis, degenerative disc disease with a specific discogenic pain pattern, lumbar stenosis with instability and recurrent lumbar disc herniation with radiculopathy. Various instrumentation techniques and graft materials are available to use in TLIF, and each option has benefits and disadvantages. Further research is needed, however, TLIF with one cage and excised local bone and augmented with a bilateral pedicle screw seems to be an effective and affordable treatment.

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