Healos graft carrier with bone marrow aspirate instead of allograft as adjunct to local autograft for posterolateral fusion in degenerative lumbar scoliosis: a minimum 2-year follow-up study.

OBJECT The objective of this study was to examine the efficacy and safety of Healos graft carrier with bone marrow aspirate and local autograft compared with the results of allograft in patients with lumbar degenerative scoliosis undergoing posterolateral fusion. METHODS Twenty-eight patients with degenerative scoliosis underwent posterolateral instrumented fusion and decompression. Patients were grouped according to the graft used. Group A consisted of 12 cases in which the authors used a Healos graft carrier, bone marrow aspirate, and local autograft, and Group B consisted of 16 cases in which the authors used cancellous allograft and local autograft. Patients were followed for a minimum of 2 years postoperatively in terms of pain (visual analog scale), function (Oswestry Disability Index), curve magnitude (Cobb angle), and fusion status (plain and dynamic radiographs). The 2 groups did not differ statistically significantly (p > 0.05) in age, sex, smoking habits, magnitude of preoperative visual analog scale score, Oswestry Disability Index score, Cobb angle, or number of levels requiring decompression and fusion. RESULTS The groups had similar (p > 0.05) results in terms of pain, function, curve progression, and fusion rates at the 2-year follow-up examination. Radiographic fusion was achieved in all but 2 cases, 1 in each group, in which the patients were asymptomatic. Patients in the allograft group (Group B) showed evidence of fusion earlier than in the Healos group (p < 0.05). No toxicity from Healos graft was recorded. CONCLUSIONS The combination of Healos hydroxyapatite sponge and bone marrow aspirate plus local allograft had significantly slower fusion rates but equal clinical outcomes compared with cancellous allograft plus local autograft when used for posterolateral fusion in patients with degenerative lumbar scoliosis.

[1]  M. Rahm,et al.  Clinical and radiographic assessment of transforaminal lumbar interbody fusion using HEALOS collagen-hydroxyapatite sponge with autologous bone marrow aspirate. , 2009, The spine journal : official journal of the North American Spine Society.

[2]  A. Ploumis,et al.  Degenerative lumbar scoliosis associated with spinal stenosis. , 2007, The spine journal : official journal of the North American Spine Society.

[3]  A. Mehbod,et al.  Degenerative Lumbar Scoliosis: Radiographic Correlation of Lateral Rotatory Olisthesis With Neural Canal Dimensions , 2006, Spine.

[4]  J. Grauer,et al.  Healos/Recombinant Human Growth and Differentiation Factor-5 Induces Posterolateral Lumbar Fusion in a New Zealand White Rabbit Model , 2006, Spine.

[5]  Matthew Shaw,et al.  Healos and Bone Marrow Aspirate Used for Lumbar Spine Fusion: A Case Controlled Study Comparing Healos With Autograft , 2006, Spine.

[6]  H. Kojima,et al.  The Use of Cultured Bone Marrow Cells in Type I Collagen Gel and Porous Hydroxyapatite for Posterolateral Lumbar Spine Fusion , 2005, Spine.

[7]  D. Grob,et al.  Ne-Osteo Bone Growth Factor for Posterolateral Lumbar Spine Fusion: Results From a Nonhuman Primate Study and a Prospective Human Clinical Pilot Study , 2004, Spine.

[8]  Daniel H. Kim,et al.  Endoscopic Instrumented Posterolateral Lumbar Fusion with Healos and Recombinant Human Growth/Differentiation Factor-5 , 2004, Neurosurgery.

[9]  T. Albert,et al.  A pilot safety and efficacy study of OP-1 putty (rhBMP-7) as an adjunct to iliac crest autograft in posterolateral lumbar fusions , 2003, European Spine Journal.

[10]  J. Connolly,et al.  Comparison of Bone Grafts for Posterior Spinal Fusion in Adolescent Idiopathic Scoliosis , 2003, Spine.

[11]  Munish C. Gupta.  Degenerative scoliosis. Options for surgical management. , 2003, The Orthopedic clinics of North America.

[12]  S. Gibson,et al.  Allograft Versus Autograft in Instrumented Posterolateral Lumbar Spinal Fusion: A Randomized Control Trial , 2002, Spine.

[13]  S. Woolf,et al.  Perceptions of Allograft Safety and Efficacy Among Spinal Deformity Surgeons , 2001, Journal of pediatric orthopedics.

[14]  Serena S. Hu,et al.  Adult scoliosis: surgical indications, operative management, complications, and outcomes. , 1999, Spine.

[15]  C. Petersilge,et al.  Augmentation of spinal arthrodesis with autologous bone marrow in a rabbit posterolateral spine fusion model. , 1999, Spine.

[16]  J. Lotz,et al.  Use of a Collagen‐Hydroxyapatite Matrix in Spinal Fusion: A Rabbit Model , 1998, Spine.

[17]  J O Hollinger,et al.  Role of bone substitutes. , 1996, Clinical orthopaedics and related research.

[18]  Marc A. Asher,et al.  Iliac Crest Bone Graft Harvest Donor Site Morbidity: A Statistical Evaluation , 1995, Spine.

[19]  Banwart Jc,et al.  Iliac crest bone graft harvest donor site morbidity. A statistical evaluation. , 1995 .

[20]  H. An,et al.  Prospective comparison of autograft vs. allograft for adult posterolateral lumbar spine fusion: differences among freeze-dried, frozen, and mixed grafts. , 1995, Journal of spinal disorders.

[21]  N. Epstein.  Efficacy of different bone volume expanders for augmenting lumbar fusions. , 2008, Surgical neurology.

[22]  E. T. Jones,et al.  Use of cortical cancellous allograft for posterior spinal fusion. , 1988, Clinical orthopaedics and related research.