Plais Nicolas, Jiménez-Herrero Enrique, Tomé-Bermejo Felix, Manzarbeitia Felix, Duart Clemente Javier Melchor, Alvarez-Galovich Luis
Servicio de Cirugía Ortopédica y Traumatología. Hospital Universitario San Cecilio de Granada, Av. Del Conocimiento, s/n, Granada, 18016, Spain.
Servicio de Cirugía Ortopédica y Traumatología. Hospital San Rafael de Granada, Granada, Spain.
Eur Spine J. 2025 Jan;34(1):156-162. doi: 10.1007/s00586-024-08476-3. Epub 2024 Sep 21.
As the number of instrumented fusions increases, so does the utilization of bone substitutes. However, controversies persist regarding the effectiveness of ceramics in promoting solid fusion. Few histological studies have been conducted on patients to address this issue. To contribute insights into this topic, we assessed bony fusion both intraoperatively and histologically in patients who underwent posterolateral instrumented fusions enhanced with a biphasic ceramic compound.
We analyzed a series of 13 patients who underwent revision surgery due to adjacent segment disease following the initial use of ceramics as bone extenders in the index surgery. In each case, patients exhibited apparent radiological fusion in the instrumented posterolateral fusions. Follow-up exceeded 18 months. Bone fusion was assessed intraoperatively, and biopsies of the bone mass at the intertransverse area were examined under an optical microscope.
Surgical exploration of the fusion block at the intertransverse space did not indicate solid fusion. Moreover, histological analysis of the 13 biopsies revealed a lack of proper integration of the bone substitutes, incomplete resorption of hydroxyapatite granules, and substitution of ceramic particles by immature fibrous tissue lacking the structural competence to bear loads or add stability to spinal fusion.
The utilization of biphasic ceramics proved ineffective in attaining a proper fusion mass between the intertransverse space. Both surgical inspection and histological studies confirmed the absence of integration. Prudence should be exercised regarding the use of ceramics. While no clear instability was observed, neither was there any integration.
随着器械辅助融合手术数量的增加，骨替代物的使用也在增加。然而，关于陶瓷在促进牢固融合方面的有效性仍存在争议。针对这一问题，很少有对患者进行的组织学研究。为了对该主题提供见解，我们对接受双相陶瓷复合物增强的后外侧器械辅助融合手术的患者进行了术中及组织学的骨融合评估。
我们分析了一系列13例患者，这些患者在初次手术中使用陶瓷作为骨延长器后因相邻节段疾病接受了翻修手术。在每种情况下，患者在器械辅助的后外侧融合中均表现出明显的影像学融合。随访时间超过18个月。术中评估骨融合情况，并在光学显微镜下检查横突间区域骨块的活检样本。
对横突间间隙融合块的手术探查未显示牢固融合。此外，对13份活检样本的组织学分析显示，骨替代物缺乏适当整合，羟基磷灰石颗粒吸收不完全，并且陶瓷颗粒被缺乏承受负荷或增加脊柱融合稳定性结构能力的未成熟纤维组织替代。
事实证明，使用双相陶瓷在横突间间隙获得适当的融合块方面是无效的。手术检查和组织学研究均证实缺乏融合。在使用陶瓷时应谨慎。虽然未观察到明显的不稳定，但也没有融合。
