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논문 기본 정보

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학술저널
저자정보
Kim, Bum-Joon (Department of Neurosurgery, Korea University Ansan Hospital) Kim, Se-Hoon (Department of Neurosurgery, Korea University Ansan Hospital) Lee, Haebin (Department of Neurosurgery, Korea University Ansan Hospital) Lee, Seung-Hwan (Department of Neurosurgery, Korea University Ansan Hospital) Kim, Won-Hyung (Department of Neurosurgery, Korea University Ansan Hospital) Jin, Sung-Won (Department of Neurosurgery, Korea University Ansan Hospital)
저널정보
대한신경외과학회 대한신경외과학회지 대한신경외과학회지 제60권 제2호
발행연도
2017.1
수록면
225 - 231 (7page)

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Objective : Solid bone fusion is an essential process in spinal stabilization surgery. Recently, as several minimally invasive spinal surgeries have developed, a need of artificial bone substitutes such as demineralized bone matrix (DBM), has arisen. We investigated the in vivo bone growth rate of DBM as a bone void filler compared to a local autologous bone grafts. Methods : From April 2014 to August 2015, 20 patients with a one or two-level spinal stenosis were included. A posterior lumbar interbody fusion using two cages and pedicle screw fixation was performed for every patient, and each cage was packed with autologous local bone and DBM. Clinical outcomes were assessed using the Numeric Rating Scale (NRS) of leg pain and back pain and the Korean Oswestry Disability Index (K-ODI). Clinical outcome parameters and range of motion (ROM) of the operated level were collected preoperatively and at 3 months, 6 months, and 1 year postoperatively. Computed tomography was performed 1 year after fusion surgery and bone growth of the autologous bone grafts and DBM were analyzed by ImageJ software. Results : Eighteen patients completed 1 year of follow-up, including 10 men and 8 women, and the mean age was 56.4 (32-71). The operated level ranged from L3/4 to L5/S1. Eleven patients had single level and 7 patients had two-level repairs. The mean back pain NRS improved from 4.61 to 2.78 (p=0.003) and the leg pain NRS improved from 6.89 to 2.39 (p<0.001). The mean K-ODI score also improved from 27.33 to 13.83 (p<0.001). The ROM decreased below 2.0 degrees at the 3-month assessment, and remained less than 2 degrees through the 1 year postoperative assessment. Every local autologous bone graft and DBM packed cage showed bone bridge formation. On the quantitative analysis of bone growth, the autologous bone grafts showed significantly higher bone growth compared to DBM on both coronal and sagittal images (p<0.001 and p=0.028, respectively). Osteoporotic patients showed less bone growth on sagittal images. Conclusion : Though DBM alone can induce favorable bone bridging in lumbar interbody fusion, it is still inferior to autologous bone grafts. Therefore, DBM is recommended as a bone graft extender rather than bone void filler, particularly in patients with osteoporosis.
#Arthrodesis #Autograft #Bone substitutes #CT scan #Osteoporosis #Spinal fusion

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참고문헌 (29)

참고문헌 신청
An HS / 1995 / Comparison between allograft plus demineralized bone matrix versus autograft in anterior cervical fusion. A prospective multicenter study / Spine 20:2211~2216 google schola Boden SD / 1995 / Biologic enhancement of spinal fusion / Spine 20(24 Suppl):113S~123S google schola Cammisa FP Jr / 2004 / Two-year fusion rate equivalency between Grafton DBM gel and autograft in posterolateral spine fusion : a prospective controlled trial employing a side-by-side comparison in the same patient / Spine 29:660~666 google schola Chalmers J / 1975 / Observations on the induction of bone in soft tissues / J Bone Joint Surg Br 57:36~45 google schola Farrokhi MR / 2012 / Posterolateral versus posterior interbody fusion in isthmic spondylolisthesis / J Neurotrauma 29:1567~1573 google schola

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