Acta Chir Orthop Traumatol Cech. 2015; 82(2):119-125 | DOI: 10.55095/achot2015/017
Posterolateral Fusion in Acute Traumatic Thoracolumbar Fractures: A Comparison of Demineralized Bone Matrix and Autologous Bone GraftOriginal papers
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany
INTRODUCTION:
Alternative fusion expanders are in clinical use for instrumented posterolateral fusion (PLF) to avoid donor site morbidity in autologous bone graft (ABG) harvesting. Purpose of this study was to evaluate demineralized bone matrix (DBM) in PLF as alternative to the gold standard of ABG in acute traumatic vertebral body fractures of the thoracolumbar spine.
MATERIAL AND METHODS:
We retrospectively identified 101 patients with acute traumatic vertebral body fractures of the thoracic and lumbar spine who were treated with instrumented PLF in our level one trauma center between 2005 and 2011. Patients with a primary paraplegia, osteodepriving disease or loss to follow-up had been excluded. Until August 2008, autologous bone graft harvested from the posterior iliac crest was used in PLF (control group n = 46). Starting September 2008, DBM was used as fusion expander in PLF (study group n = 16). Clinical and radiological evaluation was performed with a minimum follow-up of 18 months to assess the clinical and radiological outcome.
RESULTS:
We found a fusion rate of 94% in patients undergoing PLF with the use of DBM and 100% with the use of ABG. There was one major complication of deep infection in the DBM group and two cases of superficial wound infection in the ABG group. We discovered a trend of reduced operating time with the use of DBM.
CONCLUSIONS:
DBM leads to a similar fusion rate as the use of ABG in patients undergoing PLF for acute traumatic vertebral body fractures of the thoracic and lumbar spine. DBM is associated with reduced operating time.
Level of evidence III: case-control study
Keywords: demineralized bone matrix instrumented posterolateral fusion, acute traumatic vertebral body fracture, thoracolumbar spine, autologous bone graft
Published: April 1, 2015 Show citation
ACS | AIP | APA | ASA | Harvard | Chicago | Chicago Notes | IEEE | ISO690 | MLA | NLM | Turabian | Vancouver |
References
- BETZ, R. R., LAVELLE, W. F., MULCAHEY, M. J., SAMDANI. A.F.: Histology of a fusion mass augmented with demineralized bone matrix for congenital scoliosis. J. Pediatr. Orthop., 20: 37-40, 2011.
Go to original source...
Go to PubMed...
- BORMANN, N., PRUSS, A., SCHMIDMAIER, G., WILDEMANN, B.: In vitro testing of the osteoinductive potential of different bony allograft preparations. Arch. Orthop. Trauma Surg., 130: 143-149, 2010.
Go to original source...
Go to PubMed...
- BOUAICHA, S., VON RECHENBERG, B., OSTERHOFF, G., WANNER, G. A., SIMMEN, H. P., WERNER, C. M.: Histological remodelling of demineralised bone matrix allograft in posterolateral fusion of the spine - an ex vivo study. BMC Surg., 13: 58, 2013.
Go to original source...
Go to PubMed...
- CAMMISA. F. P. JR., LOWERY, G., GARFIN, S. R., GEISLER, F. H., KLARA, P. M., MCGUIRE, R. A., SASSARD, W. R., STUBBS, H., BLOCK, J. E.: Two-year fusion rate equivalency between Grafton DBM gel and autograft in posterolateral spine fusion: a prospective controlled trial employing a side-by-side comparison in the same patient. Spine, 29: 660-666, 2004.
Go to original source...
Go to PubMed...
- DROSOS, G. I., KAZAKOS, K. I., KOUZOUMPASIS, P., VERETTAS, D. A.: Safety and efficacy of commercially available demineralised bone matrix preparations: a critical review of clinical studies. Injury, 38 (Suppl. 4): S13-21, 2007.
Go to original source...
Go to PubMed...
- FOGEL, G. R., TOOHEY, J. S., NEIDRE, A., BRANTIGAN, J. W.: Fusion assessment of posterior lumbar interbody fusion using radiolucent cages: X-ray films and helical computed tomography scans compared with surgical exploration of fusion. Spine J., 8: 570-577, 2008.
Go to original source...
Go to PubMed...
- FRANKEL, H. L., HANCOCK, D. O., HYSLOP, G., MELZAK, J., MICHAELIS, L. S., UNGAR, G. H., VERNON, J. D. S., WALSH, J. J.: The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. I. Paraplegia. 1969;7: 179-192, 1969.
Go to original source...
Go to PubMed...
- GEROMETTA, A., RODRIGUEZ OLAVERRI, J. C., BITAN, F.: Infections in spinal instrumentation. Int. Orthop., 36: 457-464, 2012.
Go to original source...
Go to PubMed...
- GLOWACKI, J.: A review of osteoinductive testing methods and sterilization processes for demineralized bone. Cell Tissue Bank., 6: 3-12, 2005.
Go to original source...
Go to PubMed...
- GUERADO, E., FUERSTENBERG, C. H.: What bone graft substitutes should we use in post-traumatic spinal fusion? Injury, 42 (Suppl 2): S64-71, 2011.
Go to original source...
Go to PubMed...
- HATZOKOS, I., STAVRIDIS, S. I., IOSIFIDOU, E., KARATAGLIS, D., CHRISTODOULOU, A.: Autologous bone marrow grafting combined with demineralized bone matrix improves consolidation of docking site after distraction osteogenesis. J. Bone Jt Surg., 93-A: 671-678, 2011.
Go to original source...
Go to PubMed...
- HOFFMANN, M. F., JONES, C. B., SIETSEMA, D. L.: Adjuncts in posterior lumbar spine fusion: comparison of complications and efficacy. Arch. Orthop. Trauma Surg., 132: 1105-1110, 2012.
Go to original source...
Go to PubMed...
- KANG, J., AN, H., HILIBRAND, A., YOON, S. T., KAVANAGH, E., BODEN, S.: Grafton and local bone have comparable outcomes to iliac crest bone in instrumented single-level lumbar fusions. Spine, 37: 1083-1091, 2012.
Go to original source...
Go to PubMed...
- KNOP, C., BLAUTH, M., BUHREN, V., HAX, P. M., KINZL, L., MUTSCHLER, W., POMMER, A., ULRICH, C., WAGNER, S., WECKBACH, A., WENTZENSEN, A., WÖRSD'ORFER, O.: [Surgical treatment of injuries of the thoracolumbar transition. 2: Operation and roentgenologic findings]. Unfallchirurg, 103: 1032-1047, 2000.
Go to original source...
Go to PubMed...
- KOROVESSIS, P.: Transpedicular grafting after short-segment pedicle instrumentation for thoracolumbar burst fracture: calcium sulfate cement versus autogenous iliac bone graft. Spine, 36: 93, 2011.
- KWON, B., JENIS, L.G.: Carrier materials for spinal fusion. Spine J., 5(6 Suppl): 224S-230S, 2005.
Go to original source...
Go to PubMed...
- MAGERL, F., AEBI, M., GERTZBEIN, S. D., HARMS, J., NAZARIAN, S.: A comprehensive classification of thoracic and lumbar injuries. Eur. Spine J., 3: 184-201, 1994.
Go to original source...
Go to PubMed...
- MCCORMACK, T., KARAIKOVIC, E., GAINES, R. W.: The load sharing classification of spine fractures. Spine, 19: 1741-1744, 1994.
Go to original source...
Go to PubMed...
- MYEROFF, C., ARCHDEACON, M.: Autogenous bone graft: donor sites and techniques. J. Bone Jt Surg., 93-A: 2227-2236, 2011.
Go to original source...
Go to PubMed...
- PARKER, J. W., LANE, J. R., KARAIKOVIC, E. E., GAINES, R.W.: Successful short-segment instrumentation and fusion for thoracolumbar spine fractures: a consecutive 41/2-year series. Spine, 25: 1157-1170, 2000.
Go to original source...
Go to PubMed...
- PETERSON, B., WHANG, P. G., IGLESIAS, R., WANG, J. C., LIEBERMAN, J. R.: Osteoinductivity of commercially available demineralized bone matrix. Preparations in a spine fusion model. J. Bone Jt Surg., 86-A: 2243-2250, 2004.
Go to original source...
Go to PubMed...
- REINHOLD, M., KNOP, C., BEISSE, R., AUDIGE, L., KANDZIORA, F., PIZANIS, A., PRANZL, R., GERCEK, E., SCHULTHEISS, M., WECKBACH, A., BUHREN, V., BLAUTH, M.: Operative treatment of 733 patients with acute thoracolumbar spinal injuries: comprehensive results from the second, prospective, Internet-based multicenter study of the Spine Study Group of the German Association of Trauma Surgery. Eur. Spine J., 19: 1657-1676, 2010.
Go to original source...
Go to PubMed...
- SANDERSON, P. L., FRASER, R. D., HALL, D. J., CAIN, C. M., OSTI, O.L., POTTER, G.R.: Short segment fixation of thoracolumbar burst fractures without fusion. Eur. Spine J., 8: 495-500, 1999.
Go to original source...
Go to PubMed...
- SCHMID, R., KRAPPINGER, D., BLAUTH, M., KATHREIN, A.: Mid-term results of PLIF/TLIF in trauma. Eur. Spine J., 20: 395-402, 2011.
Go to original source...
Go to PubMed...
- Surgeons ACo. Advanced trauma life support for doctors. ACS. 8th ed. Chicago 2008.
- TRAIANEDES, K., RUSSELL, J. L., EDWARDS, J. T., STUBBS, H. A., SHANAHAN, I. R., KNAACK, D.: Donor age and gender effects on osteoinductivity of demineralized bone matrix. J. Biomed. Mater. Res., B Appl. Biomater., 70: 21-29, 2004.
Go to original source...
Go to PubMed...
- URIST, M.R.: Bone: formation by autoinduction. Science, 150: 893-899, 1965.
Go to original source...
Go to PubMed...
- VACCARO, A. R., STUBBS, H. A., BLOCK, J. E.: Demineralized bone matrix composite grafting for posterolateral spinal fusion. Orthopedics, 30: 567-570, 2007.
Go to original source...
Go to PubMed...
- VERLAAN, J. J., DIEKERHOF, C. H., BUSKENS, E., VAN DER TWEEL, I., VERBOUT, A. J., DHERT, W. J., ONER, F. C.: Surgical treatment of traumatic fractures of the thoracic and lumbar spine: a systematic review of the literature on techniques, complications, and outcome. Spine, 29: 803-814, 2004.
Go to original source...
Go to PubMed...
- WANG, S.T., MA, H. L., LIU, C. L., YU, W. K., CHANG, M. C., CHEN, T. H.: Is fusion necessary for surgically treated burst fractures of the thoracolumbar and lumbar spine?: a prospective, randomized study. Spine, 31: 2646-2652, 2006.
Go to original source...
Go to PubMed...
- WILDEMANN, B., KADOW-ROMACKER, A., HAAS, N. P., SCHMIDMAIER, G.: Quantification of various growth factors in different demineralized bone matrix preparations. J. Biomed. Mater. Res., 81: 437-442, 2007.
Go to original source...
Go to PubMed...