Artikel
Anterior lumbar interbody fusion with beta-tricalcium phosphate in comparison to bone marrow asspirate as bone graft substitute: A prospective clinical study in 50 patients
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Veröffentlicht: | 10. Oktober 2016 |
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Gliederung
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Objectives: Bone graft substitutes have been successfully used in posterolateral lumbar fusion, anterior cervical fusion and animal studies, but to date no study has been conducted to assess the safety and efficacy of beta-tricalcium phosphate in instrumented ALIF fusion.
In this prospective one-year follow-up clinical study the clinical and radiological outcome of anterior lumbar interbody fusion with beta-tricalcium phosphate as bone graft substitute was evaluated. The efficacy of beta-tricalcium phosphate as bone graft substitute in ALIF cages combined with posterolateral lumbar fusion was determined.
Methods: We conducted a prospective clinical study in 50 patients (male: 30; female: 20; mean age: 49.27 years), 33 of whom underwent single-level, 13 double-level and four triple-level anterior lumbar interbody fusion with Syncage (Synthes, Oberdorf, Switzerland) prefilled with β-TCP, and additional posterior pedicle screw fixation. Radiographic evaluation was performed with computed tomography (CT) and x-rays one year after surgery. Fusion was assessed according to a validated, published fusion scale. Functional status was evaluated with the Visual Analogue Scale and the Oswesty score before and one year after surgery.
Results and Conclusion: The Oswesty score showed a significant improvement in pain and function (P<0.05). VAS for back pain improved from 8 (7; 9) preoperatively to 2 (2; 4) postoperatively (P<0.05). VAS for leg pain improved from 7 (5; 8) preoperatively to 2 (1; 3) postoperatively (P<0.05). X-ray evaluation showed a definite fusion in 85.48% of treated levels. CT assessment showed anterior and posterior intersegemental bone bridging in 77.78% of treated levels.
The x-ray fusion rate presented is comparable with those published for ALIF procedures with bone graft. Anterior lumbar interbody fusion with beta-tricalcium phosphate and additional posterior fixation is a safe and effective procedure. Therefore ALIF surgery with beta-tricalcium phosphate is an alternative to autologous or homologous bone grafts while preventing specific complications linked with these techniques.