Posterior Lumbar Interbody Fusion with Allograft and Plates

Ohwada, Tetsuo; Yamamoto, Toshiyuki; Nose, Kazumasa; Inaoka, Masahiro; Kakiuchi, Masaaki

doi:10.1007/978-4-431-68234-9_23

Cited by 1 publication

(3 citation statements)

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“…A disadvantage of the use of iliac bone autograft alone in PLIF is graft collapse. This often results in nonunion or malunion, even though better fusion can be obtained if the pedicle screw fixation is added [9,10]. We believed that graft collapse would be prevented and bone union improved by combining the advantages of a cancellous bone autograft as a source of osteoprogenitor cells with a cortical bone allograft as a bioactive, biodegradable spacer which provided mechanical support.…”

Section: Discussionmentioning

confidence: 99%

“…Nonunion occurred in 32 of 200 (16%) patients who underwent PLIF for disc herniation using iliac bone autograft without internal fixation [10]. It was also reported that in PLIF using iliac bone autograft for disc herniation, degenerative spondylolisthesis or spondylolytic spondylolisthesis, the graft collapsed in 38 of 371 (10%) patients without internal fixation, 4 of 44 (9.1%) with Roy-Camille's pedicle screw system, and 1 of 87 (1.1%) with Steffee's VSP system [9]. In our series of Japanese patients, both the pedicle screw system and the hook and rod system decreased the incidence of delayed union or nonunion, although the former system was more effective.…”

Section: Discussionmentioning

confidence: 99%

“…There is a high incidence of graft collapse or nonunion in posterior lumbar interbody fusion (PLIF) using iliac bone autograft [9,10] because this material is not always strong enough [1], even if tri-cortical bone is used. Cortical bone from the diaphysis of the tibia or femur, whether it is an autograft or an allograft, is mechanically strong enough to serve as a strut to support the interbody fusion [7].…”

Section: Introductionmentioning

confidence: 99%

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Defatted, gas-sterilised cortical bone allograft for posterior lumbar interbody vertebral fusion

Kakiuchi

Ono

1998

International Orthopaedics

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In posterior lumbar interbody vertebral fusion operations, variously sized, rectangular shaped, defatted, freeze-dried, gas-sterilised cortical bone allografts were used in combination with cancellous bone autografts from excised posterior elements. Single-level fusion, with or without internal fixation, was undertaken in 38 patients aged 50 years or less with disc herniation or a failed discectomy (the younger group) and in 33 women aged 60 years or more with degenerative spondylolisthesis (the older group). Of the various observable indicators of union, changes in the allograft-host interface alone proved to be of practical use. The incidence of nonunion in patients managed with pedicle screws, with a hook and rod system or without internal fixation was 0 of 8 patients; 1 of 14 patients; and 3 of 16 patients, respectively, in the younger group, and 0 of 11 patients; 0 of 8 patients; and 2 of 14 patients, respectively, in the older group. Of the six patients with nonunion, three had persistent low back pain and only two had mobility of the fused segment which was evident on lateral radiographs during flexion and extension. No patient had graft collapse. The decrease in the height of the intervertebral space, chiefly due to settlement of the allograft into the vertebral bodies, in the younger and older groups averaged 1.1 and 1.6 mm, respectively. We concluded that this simplified technique is mechanically sound and effective in maintaining the height of the intervertebral space. Even when the graft failed to unite, fibrous union could be obtained without graft collapse. Combination with a simple internal fixator, such as a compression rod, facilitates bone union.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%