A comparison of posterolateral lumbar fusion comparing autograft, autogenous laminectomy bone with bone marrow aspirate, and calcium sulphate with bone marrow aspirate: a prospective randomized study.

STUDY DESIGN

A prospective clinical study.

OBJECTIVE

To evaluate whether the fusion rate of autogenous laminectomy bone chips and calcium sulfate pellets could be augmented by bone marrow aspirate (BMA) in one-level lumbar posterolateral fusion.

SUMMARY OF BACKGROUND DATA

An in vivo animal study has indicated that BMA augments spinal arthrodesis.

METHODS

Forty-three patients undergoing surgery for instrumented one-level fusion with decompression were divided into 2 groups. Autologous iliac crest bone graft (ICBG) was placed in 1 posterolateral gutter (control), while on the other side (test), an equal quantity of laminectomy bone chips mixed with BMA while harvesting the iliac bone graft (group 1) or an equal quantity of calcium sulfate pellets soaked in BMA (group 2) was placed. Radiographic assessment was performed every 3 months (3-12 months) and then annually. The statuses of fusion on either side of the vertebra were compared.

RESULTS

For the 21 patients in group 1, 18 (85.7%) exhibited bone fusion on the test side, and 19 (90.5%) presented evidence of fusion on the control side. Thus, the test side with laminectomy bone chips and BMA achieved a fusion rate similar to that on the control side (P > 0.05). For the 22 patients in group 2, 20 (90.9%) exhibited bone fusion on the control side whereas only 10 (45.5%) demonstrated complete fusion on the test side (P < 0.05), where calcium sulfate and BMA was applied.

CONCLUSION

ICBG performs as expected with high fusion rates and laminectomy bone with BMA performs equally as well. Osteoset is significantly inferior to ICBG despite the addition of BMA, which is osteoinductive and has improved fusion rates and osteogenesis in other models.