Hostin Richard, O'Brien Michael, McCarthy Ian, Bess Shay, Gupta Munish, Klineberg Eric
*Baylor Scoliosis Center, Plano†Institute for Health Care Research and Improvement, Baylor Health Care System‡Southern Methodist University, Dallas, TX§Rocky Mountain Scoliosis and Spine, Denver, CO∥Department of Orthopaedic Surgery, University of California Davis Health System, Sacramento, CA.
Clin Spine Surg. 2016 Oct;29(8):E384-8. doi: 10.1097/BSD.0b013e318292468f.
Retrospective, single-center analysis of multilevel anterior fusion rates and health-related quality-of-life outcomes of mineralized collagen and bone marrow aspirate (BMA) in anterior interbody fusion cages for spine fusion surgery.
To determine the ability and effectiveness of mineralized collagen and BMA to achieve multilevel anterior spinal fusion in adult spinal deformity patients when placed in carbon fiber reinforced polymer cages.
High rates of postoperative pain and nonunion can result from spine fusion procedures. Factors that affect the success of fusion include patient comorbidities, position of implant, and mechanical and biological deficiencies, as well as the choice of bone graft replacement.
Analysis of radiographic images and health-related quality-of-life outcomes was performed for a consecutive series of 22 prospectively enrolled adult spinal deformity patients with 104 total anterior fusion levels. Fusions were graded by 3 blinded surgeons not involved in the operative procedure; each fusion was graded on a 1-4 scale based on fusion mass appearance. Levels with an average fusion grade of 1-2.4 were classified as fused; levels with an average grade >2.5 were classified as not fused.
The mean patient age was 51.5 years (range, 38-61) with 21 females. A total of 95% of anterior operative levels were graded as fused based on flexion/extension and full-length biplane radiographs at 1 year. Computed tomography grading showed a reduced fusion rate at 87% overall. There was a statistically significant improvement in the Oswestry Disability Index and Scoliosis Research Society 22-item questionnaire scores at 1 and 2 years after index surgery.
Fusion rates in multilevel anterior spinal fusion using mineralized collagen and BMA are relatively low compared with fusion rates of 95% or more reported in the existing literature on long fusions with bone morphogenetic protein.
对用于脊柱融合手术的前路椎间融合器中矿化胶原蛋白和骨髓抽吸物（BMA）的多级前路融合率及健康相关生活质量结果进行回顾性单中心分析。
确定矿化胶原蛋白和BMA置于碳纤维增强聚合物椎间融合器中时，在成人脊柱畸形患者中实现多级前路脊柱融合的能力和有效性。
脊柱融合手术可能导致术后疼痛和不愈合发生率较高。影响融合成功的因素包括患者合并症、植入物位置、机械和生物学缺陷以及骨移植替代物的选择。
对连续纳入的22例成年脊柱畸形患者（共104个前路融合节段）进行影像学图像分析及健康相关生活质量结果评估。由3名未参与手术的盲法外科医生对融合情况进行分级；根据融合块外观，每个融合节段按1 - 4级评分。平均融合分级为1 - 2.4级的节段归类为融合；平均分级>2.5级的节段归类为未融合。
患者平均年龄为51.5岁（范围38 - 61岁），女性21例。基于1年时的屈伸位和全长双平面X线片，95%的前路手术节段被评为融合。CT分级显示总体融合率为87%。在初次手术后1年和2年，Oswestry功能障碍指数和脊柱侧凸研究学会22项问卷评分有统计学意义的改善。
与现有关于骨形态发生蛋白长期融合的文献报道的95%或更高的融合率相比，使用矿化胶原蛋白和BMA进行多级前路脊柱融合的融合率相对较低。
