Comparison of Fusion Rates between Autologous Iliac Bone Graft and Calcium Sulfate with Laminectomy Bone Chips in Multilevel Posterolateral Spine Fusion
2013
Multilevel lumbar fusion usually requires a large quantity of iliac
crest bone graft but the supply is usually insufficient, so an alternative bone graft substitute for autograft is
needed. This prospective study investigated the efficacy of calcium sulfate by
comparing the fusion rates between the experimental material (calcium sulfate
pellets with bone chips from laminectomy) and autologous iliac bone graft in
long segment (three-or four-level) lumbar and lumbosacral posterolateral
fusion. Forty-five patients with degenerative scoliosis or spondylolisthesis
received multilevel spine fusion and decompression. The experimental material
of calcium sulfate pellets with decompression bone chips was placed on the
experimental side and the iliac crest bone graft was placed on the control
side. The fusion status was assessed radiographically at three-month intervals,
and solid fusion was defined as a clear continuous intertransverse bony bridge
at all levels. The average follow-up period was 34.4 months. Twenty-nine
(64.4%) patients showed solid fusion on the experimental side and 39 (86.7%)
patients on the control side. The overall fusion rate was 86.7%. A statistically
significant relation was found between
the two sides with the Kappa coefficient of agreement of 0.436. Compared to the control side, the fusion rate of experimental side is
significantly reduced (p = 0.014). The fusion ability of autograft
is higher than the experimental material in multilevel lumbar posterolateral
fusion. However, the overall fusion rate of calcium sulfate pellets is improved,
compared with previously reported rates, which suggested that such material may
be considered as an acceptable bone graft extender.
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