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

Clinical article

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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.

Abbreviations used in this paper: HA = hydroxyapatite; ODI = Oswestry Disability Index; VAS = visual analog scale.

Article Information

Address correspondence to: Avraam Ploumis, M.D., Ph.D., Rothman Institute, 925 Chestnut Street, Philadelphia, Pennsylvania 19107. email: aploumis@cc.uoi.gr.

© AANS, except where prohibited by US copyright law.

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Figures

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    Preoperative anteroposterior radiograph of the lumbar spine obtained in a 62-year-old woman with degenerative lumbar scoliosis and spinal stenosis.

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    A: Final anteroposterior radiograph of the same patient featured in Fig. 1, following posterolateral decompression and fusion (L4–S1) with Healos carrier, bone marrow, and local autograft. No radiolucencies are observed within the fusion mass. The L1–5 Cobb angle is stable postoperatively. B and C: Flexion and extension radiographs showing no abnormal motion at fused vertebrae.

References

  • 1

    An HSLynch KToth J: Prospective comparison of autograft vs. allograft for adult posterolateral lumbar spine fusion: differences among freeze-dried, frozen, and mixed grafts. J Spinal Disord 8:1311351995

    • Search Google Scholar
    • Export Citation
  • 2

    Banwart JCAsher MAHassanein RS: Iliac crest bone graft harvest donor site morbidity. A statistical evaluation. Spine 20:105510601995

    • Search Google Scholar
    • Export Citation
  • 3

    Boden SDGrob DDamien C: Ne-Osteo bone growth factor for posterolateral lumbar spine fusion: results from a nonhuman primate study and a prospective human clinical pilot study. Spine 29:5045142004

    • Search Google Scholar
    • Export Citation
  • 4

    Bradford DSTay BKHu SS: Adult scoliosis: surgical indications, operative management, complications, and outcomes. Spine 24:261726291999

    • Search Google Scholar
    • Export Citation
  • 5

    Carter JDSwearingen ABChaput CDRahm MD: Clinical and radiographic assessment of transforaminal lumbar interbody fusion using HEALOS collagen-hydroxyapatite sponge with autologous bone marrow aspirate. Spine J 9:4344382009

    • Search Google Scholar
    • Export Citation
  • 6

    Curylo LJJohnstone BPetersilge CAJanicki JAYoo JU: Augmentation of spinal arthrodesis with autologous bone marrow in a rabbit posterolateral spine fusion model. Spine 24:4344391999

    • Search Google Scholar
    • Export Citation
  • 7

    Epstein NE: Efficacy of different bone volume expanders for augmenting lumbar fusions. Surg Neurol 69:16192008

  • 8

    Gibson SMcLeod IWardlaw DUrbaniak S: Allograft versus autograft in instrumented posterolateral lumbar spinal fusion: a randomized control trial. Spine 27:159916032002

    • Search Google Scholar
    • Export Citation
  • 9

    Gupta MC: Degenerative scoliosis. Options for surgical management. Orthop Clin North Am 34:2692792003

  • 10

    Hollinger JOBrekke JGruskin ELee D: Role of bone substitutes. Clin Orthop Relat Res 324:55651996

  • 11

    Jahng TAFu TSCunningham BWDmitriev AEKim DH: Endoscopic instrumented posterolateral lumbar fusion with Healos and recombinant human growth/differentiation factor-5. Neurosurgery 54:1711812004

    • Search Google Scholar
    • Export Citation
  • 12

    Knapp DR JrJones ET: Use of cortical cancellous allograft for posterior spinal fusion. Clin Orthop Relat Res 229:991061988

  • 13

    Magit DPMaak TTrioano NRaphael BHamouria QPolzhofer G: Healos/recombinant human growth and differentiation factor-5 induces posterolateral lumbar fusion in a New Zealand white rabbit model. Spine 31:218021882006

    • Search Google Scholar
    • Export Citation
  • 14

    Minamide AYoshida MKawakami MYamasaki SKojima HHashizume H: The use of cultured bone marrow cells in type I collagen gel and porous hydroxyapatite for posterolateral lumbar spine fusion. Spine 30:113411382005

    • Search Google Scholar
    • Export Citation
  • 15

    Neen DNoyes DShaw MGwilym SFairlie NBirch N: Healos and bone marrow aspirate used for lumbar spine fusion: a case controlled study comparing healos with autograft. Spine 31:E636E6402006

    • Search Google Scholar
    • Export Citation
  • 16

    Ploumis ATransfledt EEDenis F: Degenerative lumbar scoliosis associated with spinal stenosis. Spine J 7:4284362007

  • 17

    Ploumis ATransfeldt EEGilbert TJ JrMehbod AADykes DCPerra JE: Degenerative lumbar scoliosis: radiographic correlation of lateral rotatory olisthesis with neural canal dimensions. Spine 31:235323582006

    • Search Google Scholar
    • Export Citation
  • 18

    Price CTConnolly JFCarantzas ACIlyas I: Comparison of bone grafts for posterior spinal fusion in adolescent idiopathic scoliosis. Spine 28:7937982003

    • Search Google Scholar
    • Export Citation
  • 19

    Tay BKLe AXHeilman MLotz JBradford DS: Use of a collagen-hydroxyapatite matrix in spinal fusion. A rabbit model. Spine 23:227622811998

    • Search Google Scholar
    • Export Citation
  • 20

    Vaccaro ARPatel TFischgrund JAnderson DGTruumees EHerkowitz H: A pilot safety and efficacy study of OP-1 putty (rhBMP-7) as an adjunct to iliac crest autograft in posterolateral lumbar fusions. Eur Spine J 12:4955002003

    • Search Google Scholar
    • Export Citation
  • 21

    Woolf SKGross RH: Perceptions of allograft safety and efficacy among spinal deformity surgeons. J Pediatr Orthop 21:7677712001

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