Comparison of Cage and Allograft Mixed Bone Marrow for Monosegmental Instrumented Posterior Lumbar Interbody Fusion

STUDY DESIGN: A retrospective study. OBJECTIVES: To compare the radiological and clinical results between cage and cancellous allograft mixed with bone marrow for monosegmental instrumented posterior lumbar interbody fusion (PLIF). SUMMARY OF THE LITERATURE REVIEW: Allograft has potential problems, such as delayed union. Autologous bone marrow provides for improving the capability of bone induction with allograft. There are rare reports on PLIF using allograft mixed with autologous bone marrow. MATERIALS AND METHODS: Monosegmental instrumented PLIF was performed on 51 patients who had lumbar degenerative disease, cage for 28 patients (cage group) and allograft mixed with bone marrow for 23 patients (allograft group). The clinical and radiological results in each group were compared. RESULTS: The mean follow-up was 45 (30 - 111) months. At the final follow up, there was no significant difference between the cage group and the allograft group in the Korean Version Oswestry Disability Index (p=0.72) and Visual Analogue Score for back pain (p=0.54) and radiating pain to the leg (p=0.26). The radiological fusion rate was 92.8% in the cage group, and 82.6% in the allograft group (p=0.02). At the last follow up, disc height was decreased to 1.5+/-0.8 mm of the cage group, and 3.0+/-1.5 mm of the allograft group (p=0.0001). CONCLUSIONS: PLIF using cancellous allograft mixed bone marrow has low fusion rate contrast to good clinical results. It is necessary to take a careful selection of the allograft mixed bone marrow for PLIF.

Femoral Revision Hip Arthroplasty with the Use of Impacted Cancellous Allograft and Cement

PURPOSE: To evaluate the radiographic mid-to long-term result of femoral revision hip arthroplasty using impacted cancellous allograft combined with cemented, collarless, polished and tapered stem. MATERIALS AND METHODS: Among 27 patients with impacted cancellous allograft with a cemented stem, 28 hips from 26 consecutive patients were analyzed retrospectively. The average patient age was 59 years. The follow-up period ranged 36 months to 10 years, 3 months (mean, 76.6 months). Radiographic parameters analyzed in this study included subsidence of the stem in the cement, subsidence of the cement mantle in the femur, bone remodeling of the femur, radiolucent line, and osteolysis. RESULTS: Radiographic analysis showed very stable stem initially. 27 stems showed minimal subsidence (less than 5mm) and 1 stem showed moderate subsidence (about 8 mm) in the cement. But there was no mechanical failure and subsidence at the composit-femur interface. Evidence of cortical and trabecular remodeling were observed in all cases. No radiolucent line or osteolysis were found in the follow-up period. There were 4 proximal femoral cracks and 1 distal femoral splitting during operation. CONCLUSION: The result of cemented stem revision with the use of impacted cancellous allograft was good mid-to long-term. and femoral bone stock deficiency may be reconstructed successfully.

Treatment of Simple Bone Cysts with Percutaneous Injection of Autogenous Bone Marrow with Crushed Cancellous Allograft / 대한정형외과학회잡지

PURPOSE: This study evaluated the feasibility and efficacy of a percutaneous injection of a mixture of autogenous bone marrow and crushed cancellous bone allografts for the treatment of simple bone cysts. MATERIALS AND METHODS: Fifteen patients with a simple bone cyst were enrolled in this study. The mean age was 13.5 years (range, 4-32 years), and the mean follow-up period was 13.2 months (range, 8-19 months). The radiographic signs of the resolution of the cyst were categorized as healed, healed with a defect, persistent and recurrent. The groups of healed and healed with a defect were designated the positive response groups. RESULTS: Fourteen patients responded to the treatment. Nine patients showed complete healing that was first seen radiographically at 3 months (range, 1-6 months). Five patients showed healing with a defect, but no patient required a second injection because the cysts were small and did not cause functional pain. There was no correlation between clinical responses and age, gender, location, cyst index and previous treatment modalities. One patient had a pathological fracture, which was treated successfully by open bone grafting with flexible intramedullary nailing. CONCLUSION: A percutaneous injection of a mixture of autogenous bone marrow and a crushed cancellous bone allograft may be an effective treatment for simple bone cysts.

Posterior Lumbar Interbody Fusion with Cancellous Allograft / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study. OBJECTIVES: This study compared the clinical results of the posterior lumbar interbody fusion (PLIF) using a cancellous allograft with the conventional autologous iliac bone graft. SUMMARY OF LITERATURE REVIEW: The allograft is known to produce a similar effect as that of a nonvascular autogenous bone implantation. However, the implantation process occurs more slowly with the various degrees of the inflammatory reaction caused by the immunological reactions. MATERIALS AND METHODS: From June 1999 to February 2002, 39 patients were operated on by a single surgeon. There were 14 cases with 1 level, 4 cases with 2 levels posterior fusion with a cancellous allograft (objective group), and 20 cases with 1 level and 1 case with 2 levels posterior fusion with a conventional bone graft (control group). The clinical results and standing lateral views of the lumbar spine were compared and analyzed in order to assess the fusion rate, the changes in the distance between the two vertebral bodies and changes in the lordotic angle formed between the fused bodies immediate after surgery and at the final follow-up. RESULTS: During the early post-operative period, the control group showed superior results. However, there were no significant differences between the two groups at the final follow-up. There were no statistically significant differences in the fusion rate, the changes in the intervertebral distance, and the lordotic angle. CONCLUSION: PLIF using a cancellous allograft and a locally harvested autograft showed acceptable radiological union rate and clinical results. It is believed that this is an excellent surgical technique with a shorter operation time, less bleeding, less pain and no morbidity of the donor site.