Open Access, Peer-reviewed
pISSN 2093-4378
eISSN 2093-4386
    J Korean Soc Spine Surg. 2008 Sep;15(3):157-164. Korean.
    Published online Sep 30, 2008.
    https://doi.org/10.4184/jkss.2008.15.3.157
    Copyright © 2008 Korean Society of Spine Surgery
    Original Article

    The Effect of Demineralized Bone Matrix as a Graft Enhancer in Posterior Lumbar Interbody Fusion Using Cage and Local Bone Chips

    Dae Jung Choi, M.D., Dong Ki Ahn, M.D., Song Lee, M.D., Hoon Seok Park, M.D., Young Won Jeon, M.D., Seung Jin Yang, M.D. and Chang Wook Ryu, M.D.
      • Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea.
    • Address reprint requests to: Dong Ki Ahn, M.D. Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, 40-12 Chungryangri-dong, Dongdaemoon-gu, Seoul, Korea. Tel: 82-2-966-1616, Fax: 82-2-968-2394, Email: adkajs@hanmail.net

    Abstract

    Study Design

    A randomized, controlled study

    Objectives

    We wanted to investigate whether osteogenesis can be enhanced when a small amount of demineralized bone matrix (1 cc/segment) is mixed with local bone chips.

    Summary of the Literature Review

    Demineralized bone matrix (DBM) has been used for spinal arthrodesis. However, there are only a few reports about its use as a composite graft with local bone chips for posterior lumbar interbody fusion.

    Materials and Methods

    Degenerative spine patients, who would normally be treated by decompression and posterior lumbar interbody fusion with using a pedicle screw system and one cage, were randomly, prospectively selected for whether they would be treated with using local bone chips mixed with 1cc of DBM (Group I: 15 patients and 19 segments) or local bone chips (Group II: 12 patients and 13 segments) for graft material. The sampling bias was investigated for gender, age, endocrine diseases, previous operation, habits (alcohol drinking, smoking), steroid medication, bone mineral density and the amount of local bone. The amount of bone formation was measured at 6 months after operation. On the sagittal and coronal reconstruction CT images, the bone formation outside of the cage was measured, and this was interpreted in a "blinded" fashion by 2 independent doctors who did not take part in the operations.

    Results

    There was no sampling bias between the 2 groups except for age (Group I= 65.3±7.1, Group II=58.9±6.0, p=0.010). The ratio of local bone chips and DBM was 5.98:1 in Group I. There was moderate concurrence between the 2 interpreters (kappa co-efficiency=0.494, p<0.001 for the sagittal plain images and kappa co-efficiency=0.467, p<0.001 for the coronal plain images) and Group I showed significantly more bone formation (p=0.003).

    Conclusion

    DBM that is mixed with local bone chips, even with small amount, enhanced bone formation in the posterior lumbar interbody fusion. This is regarded to act as a graft enhancer to increase the fusion rate, even when using local bone chips for graft material, for the cases that show unfavorable conditions for fusion or for the cases that are prone to loosening of hardware.

    Keywords
    Posterior lumbar interbody fusion; Demineralized bone matrix; Local bone chips; Graft enhancer

    Figures

    Fig. 1
    PLIF with pedicle screws and one cage augmented with local bone chips.

    Fig. 2
    Measurement of local bone amount and 1 cc of DBM.

    Fig. 3
    Bone formation grading system which is measured at out of cage, mid-sagittal and anterior one third coronal plane CT reconstruction view. (A) Grade I: no or little bone formation at graft site. (B) Grade II: bone formation less than 50% at graft site. (C) Grade III: bone formation more than 50% at graft site. (D) Grade IV: full bone formation at graft site and continuing to adjacent end plates.

    Tables

    Table 1
    Sampling bias

    Table 2
    Bone formation score

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    MeSH Terms
    Arthrodesis
    Bone Density
    Bone Matrix
    Decompression
    Drinking
    Endocrine System Diseases
    Humans
    Osteogenesis
    Prospective Studies
    Selection Bias
    Spine
    Transplants
    Metrics
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