RESUMO
OBJECTIVES: Using a retrospective analysis on the fusion rate and the postoperative improvement in symptoms, this study evaluated the clinical feasibility of a bone graft in lumbar fusion surgery in the following cases: (1) Group I: local autograft, (2) Group II: local autograft and iliac crest autograft, and (3) Group III: local autograft and customized heterograft. MATERIALS AND METHODS: Among the patients who had undergone a decompression and lumbar posterolateral fusion for various lumbar diseases, between January 1997 and December 1999, 178, in who 2 year follow-up observations had been possible, were selected for this study. The patients were allocated to 1 of 3 groups, Group I (47 patients), Group II (57 patients) and Group III (74 patients). For each group, the mean patient ages were 58.3, 49 and 62.4 years old, respectively, with male to female ratios of 24:23, 23:24 and 36:38. Postoperative radiographs were taken at 2 weeks, 3 months and 1 year, and further follow-up observations were conducted at 1-year intervals. The bone fusions was determined, along with the fusion rates, based on Lenke's criteria, and the post-operative clinical outcomes were evaluated as excellent, good, normal and poor, using Kim's method. A statistical analysis was performed with Chi-square tests. RESULTS: From the follow-up observations for over a year, the radiographic evaluations showed that the fusion rates of Groups I and II, over B: 86.6 and over B: 88.9%, were superior to the over B: 80.1% of Group III, but with no statistical significance. For the clinical outcomes, the 78.1 88% over good results were superior to the 69.4% of Group III, which also showed statistical significance. CONCLUSIONS: The selective use of customized heterograft was assumed to be effective in an insufficient autogenous bone or a difficult autogenous bone collection even though it causes significantly lower improvement in the symptoms.