Synthetic porous ceramic compared with autograft in scoliosis surgery

Abstract

We have evaluated the use of a synthetic porous ceramic (Triosite) as a substitute for bone graft in posterior spinal fusion for idiopathic scoliosis. In a prospective, randomised study 341 patients at five hospitals in the UK and France were randomly allocated either to autograft from the iliac crest or rib segments (171) or to receive Triosite blocks (170). All patients were assessed after operation and at 3, 6, 12 and 18 months.The two groups were similar with regard to all demographic and baseline variables, but the 184 treated in France (54%) had Cotrel-Dubouset instrumentation and the 157 treated in the UK usually had Harrington-Luque implants. In the Triosite group the average Cobb angle of the upper curve was 56°, corrected to 24° (57%). At 18 months, the average was 26° (3% loss). In the autograft group the average preoperative upper curve of 53° was corrected to 21°( 60%). At 18 months the mean curve was 25° (8% loss). Pain levels after operation were similar in the two groups, being mild in most cases. In the Triosite group only three patients had problems of wound healing, but in the autograft group, 14 patients had delayed healing, infection or haematoma in the spinal wound. In addition, 15 autograft patients had pain at the donor site at three months. Seven had infections, two had haematoma and four had delayed healing.The haematological and serum biochemistry results showed no abnormal trends and no significant differences between the groups. There were no adverse events related to the graft material and no evidence of allergenicity.Our results suggest that Triosite synthetic porous ceramic is a safe and effective substitute for autograft in these patients. Histological findings on biopsy indicate that Triosite provides a favourable scaffolding for the formation of new bone and is gradually incorporated into the fusion mass.

?-tricalcium phosphate as a bone substitute for dorsal spinal fusion in adolescent idiopathic scoliosis: preliminary results of a prospective clinical study

“…The patients were grafted with autologous bone (n=171) or synthetic porous ceramic (n=170) [17]. They also found a loss of correction of 8% in the autograft group versus 3% in ceramic group.…”

“…In previous studies of treatment of idiopathic scoliosis with synthetic bone substitutes, blocks or sticks of TCP composites were used (biphasic ceramic TCP/HA [15,17], composite collagen/TCP [11]). The aim of this prospective study is to evaluate the performance of TCP in granular form in human dorsal spine fusion and to assess the quality of bone fusion obtained in the treatment of adolescent idiopathic scoliosis.…”

Physical and chemical aspects of calcium phosphates used in spinal surgery

“…Most commercial products, e.g., Triosite (Zimmer, USA) and BCP (Sofamor Danek, France), contain 60% HA and 40% β-TCP. BCP has been widely used in spinal surgery, e.g., for scoliosis [41,43].…”

Modelling the mechanical properties of microporous and macroporous biphasic calcium phosphate bioceramics

“…[1][2][3] Among them, the mostly used ones are hydroxyapatite (HA), Ca 10 (PO 4 ) 6 (OH) 2 , which structure is close to that of biological apatites, ␤-tricalcium phosphate (TCP), Ca 3 (PO 4 ) 2 , [4][5][6] and biphasic calcium phosphates (BCP) made of a mixture of HA and TCP. They have the advantage to combine the physicochemical properties of both compounds: the dissolution of TCP allows to obtain a local calcium and phosphate ion supersaturation, and the nucleation properties of HA favour the precipitation of biological apatites.…”