A preliminary study of the efficacy of Beta Tricalcium Phosphate as a bone expander for instrumented posterolateral lumbar fusions.

Abstract

The associated morbidity of allograft(s) as bone graft expanders in spinal surgery has prompted the search for alternatives. The efficacy of Vitoss/Beta Tricalcium Phosphate (B-TCP: OrthoVita, Malvern PA, USA), an artificial bone substitute, combined with lamina autograft (50:50 mix) in 40 prospective posterolateral fusions utilizing pedicle/screw instrumentation was analyzed. Multilevel lumbar laminectomies (average 3.7 levels) were accompanied by 1 (27 patients) and 2 level (13 patients) fusions. Two neuroradiologists independently assessed fusion progression on dynamic x-rays and 2D-CT studies performed at 3, 6, and up to 12 months postoperatively. Outcomes were quantified utilizing Odom Criteria and Short-Form 36 (SF-36) questionnaires (preoperatively; and 3, 6, and 12 months postoperatively). By the sixth postoperative month, fusion was neuroradiologically confirmed on both dynamic x-rays and CT studies for 26 of 27 single level fusions (1 pseudarthrosis), and 11 of 13 two level fusions (L4-S1). Odom Criteria 3, 6, and 12 months postoperatively revealed continued improvement for all patients. SF-36 outcomes, however, revealed deterioration on 2 Health Scales (Role Physical, Role Emotional) 3 and 6 months post-operatively, and minimal to marked improvement on 6 Health Scales (PF, V, PF, V, SF, BP). Twelve months postoperatively improvement occurred on all 8 Health Scales, exceeding pre-operative baselines; minimal (RP, GH), mild (MH), moderate (PF, BP, V, SF), and marked improvement (RE). Although Vitoss/B-TCP and laminar autograft resulted in pseudarthrosis for 1 of 27 single level and 2 of 13 two level posterolateral instrumented lumbar fusions, only 1 of the latter patients required a secondary fusion.

• Authors: Nancy E Epstein
• Journal: Journal of spinal disorders & techniques (J Spinal Disord Tech) Vol. 19 Issue 6 Pg. 424-9 (Aug 2006) ISSN: 1536-0652 [Print] United States
• PMID: 16891978 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Bone Substitutes
• Calcium Phosphates
• beta-tricalcium phosphate

Topics

• Adult
• Aged
• Aged, 80 and over
• Bone Substitutes (administration & dosage)
• Calcium Phosphates (administration & dosage)
• Combined Modality Therapy
• Female
• Humans
• Lumbar Vertebrae (diagnostic imaging, surgery)
• Male
• Middle Aged
• Pilot Projects
• Radiculopathy (diagnostic imaging, therapy)
• Radiography
• Spinal Fusion (instrumentation, methods)
• Treatment Outcome