A clinical comparison of three bone graft materials for posterior lumbar interbody fusion

LI Zhong-hai; LIU Mo-zhen; ZHAO Yan-tao; ZHONG Hong-bin; LI Li; HOU Shu-xun; ZHANG Hai-long; HOU Tie-sheng

doi:10.3969/j.issn.2095-252X.2018.03.015

Abstract：Objective To observe the clinical and radiological results of posterior lumbar interbody fusion with 3 different types of bone grafting materials, and to evaluate the safety and efficiency. Methods Between September 2013 and December 2016, 97 consecutive patients seeking medical treatment for one level lumbar degenerative disease were included in this study. There were 43 cases of lumbar spinal stenosis, 22 cases of lumbar spondylolisthesis and 32 cases of lumbar disc herniation with lumbar instability. There were 51 males and 42 females, aged 39 to 70 years ( mean: 52.4 years ). The level of pathology: L3-4in 15 cases, L4-5in 52 cases, L5- S1in 30 cases. All cases were treated with allogeneic freeze-dried bone ( group A ), autologous cancellous bone ( group B ) and demineralized bone matrix ( DBM ) ( group C ) combined with posterior internal fixation after decompression and discectomy. Preoperative data and follow-up results were evaluated by Oswestry disability index ( ODI ) and the visual analogue scales ( VAS ) for low back pain and leg pain. Fusion rate, fusion duration, disc height index ( DHI ) of the operative segment, and failure of internal fixation were recorded and statistically analyzed. There were no significant differences in general data among 3 groups ( P > 0.05 ). Results There were no significant differences in the operation time and bleeding volume among the three groups ( P > 0.05 ). Group A: 39 cases were followed up for 12 - 48 months;wound effusion was found in 3 cases, and other incisions healed by the first intention; the time range of bone graft healing was ( 15.8 ± 4.3 ) months; 4 cases ( 11.8% ) were noted with nonfusion, including 2 cases of screw fracture; the lowest fusion rate, longest time range of fusion, highest rate of internal fixation failure and height loss of intervertebral space, with statistical significance compared with the other 2 groups ( P < 0.05 ). Group B: 31 cases were followed up for 13 - 49 months; no infection occurred. Group C: 27 cases were followed up for 10 - 18 months; no infection occurred. Group B and Group C achieved fusion rates of 96.2% and 92.0%, and the time of bone graft healing were ( 12.7 ± 4.8 ) months and ( 13.5 ± 4.5 ) months, respectively. Between the 2 groups, there were no significant differences in respects of fusion rate and bone graft healing time ( P > 0.05 ). Conclusions Among the 3 types of bone grafting materials, allogeneic bone has the lowest fusion rate and instrumentation failure. Satisfactory outcomes are achieved in autologous cancellous bone and DBM, and there are no significant differences between them. It is a safe and effective way to enhance the posterior lumbar interbody fusion with the DBM.