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Type of bone grafting material for TLIF had little effect on fusion rates

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LYON, France — Two groups of patients who underwent 1-level or 2-level transforaminal lumbar interbody fusion with either autologous iliac crest bone or an equal amount of local bone mixed with synthetic hydroxylapatite achieved similar clinical and radiographic outcomes through the 12-month follow-up, according to data presented here.

According to Nicolas H. Von der Hoeh, MD, who presented the findings at the EuroSpine Annual Meeting, there are limited clinical data about results of mixing equal parts of autologous bone and the synthetic hydroxylapatite bone compared to iliac crest bone graft (ICBG), which is the gold standard.

In the prospective, randomized, single-blinded study, Von der Hoeh and colleagues studied 40 patients who had degenerative lumbar pathologies. Group A received a 10 mL volume of ICBG and group B received a 5 mL volume of autologous bone from their bony decompression and 5 mL of the synthetic bone. Investigators uses bony fusion on X-ray and lumbar CT scans as the primary endpoint. At the follow-up appointments 6 weeks, 6 months and 12 months after surgery, they evaluated secondary variables in the patients, which included donor site morbidity and clinical outcomes with the VAS, Oswestry Disability Index (ODI) and SF-36 scores.

“We see similar results between group A and group B in fusion rate and also on the X-ray and on CT scan, and there was no difference — no significant difference — in the clinical outcomes, and we see a good decrease of the VAS and ODI,” Von der Hoeh said.

Both groups of patients experienced some complications, such as one instance each of wound infection and cage subsidence in group A and persistent pain reported by two patients in group B.

“We can say that a mix can be used for one or two levels of spondylodesis to avoid donor site morbidity,” Von der Hoeh said.

The small sample size used was one of the study’s weaknesses and it may have affected the ability to detect differences between the groups beyond what the investigators found, Von der Hoeh said. He and his colleagues hope to conduct a similar study with more patients who are followed up for 2 years. – by Susan M. Rapp

Reference:

Von der Hoeh NH. Paper #QF57. Presented at: EuroSpine Annual Meeting; Oct. 1-3, 2014; Lyon, France.

Disclosure: The study was supported by Medtronic.