Effectiveness of Utilizing Local Bone Graft plus Hydroxyapatite with or without Bone Marrow Aspiration from Vertebral Body in Posterolateral Lumbar Fusion: a Randomized-Controlled Trial

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Sayun Sumethvanich
Anuwat Paiboon


Background: Decompression laminectomy and instrumented fusion are common surgical treatments for degenerative lumbar spinal stenosis. Long-term results depend on a successful fusion. Autologous iliac bone grafting (AIBG) is the gold standard for posterolateral fusion, but AIBG harvesting can cause complications. Local bone graft (LBG) and hydroxyapatite (HA) are implemented as substitutes for AIBG. However, the osteoprogenitor cells and osteoinductive properties are still deficient in these procedures. The addition of intraoperative bone marrow aspiration (BMA) from the vertebral body to mix with LBG and HA may solve this problem.
Objectives: To compare the fusion rate of lumbar laminectomy with PLF and instrumentation between those using LBG+HA+BMA and those using LBG+HA.
Material and methods: A randomized-controlled trial was conducted among 95 patients with degenerative lumbar spinal stenosis who underwent laminectomy with PLF and instrumentation in Lampang Hospital between
April 2019 and September 2022. LBG, HA, and BMA were added to the fusion sites in the study group (n=48), whereas LBG and HA were utilized in the control group (n=47). Successful fusion was determined at 6 and 12 months postoperatively by the computerized tomography using Christiansen’s classification criteria. Intraoperative blood loss, operative time, length of stay, and surgical site infection were compared between the two groups.
Results: The study group achieved a significantly higher fusion rate than the control group at 6 months (39.6% vs. 12.8%, p=0.005). This higher fusion rate remained at 12 months but was marginally significant (75.0% vs. 55.3%, p=0.054). Subgroup analysis found the significantly higher fusion rate of the study group in the patients with 2–3 fusion levels (85.2% vs. 58.1%, p=0.042). Both groups demonstrated similar outcomes in terms of perioperative blood loss, operative time, length of hospital stay, and surgical site infection.
Conclusion: Adding BMA from the vertebral body could improve the fusion rate in lumbar laminectomy with PLF and instrumentation that used a combination of LBG and HA at 6 months and 2–3 fusion levels at 12 months

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Sumethvanich, S., & Paiboon , A. . (2023). Effectiveness of Utilizing Local Bone Graft plus Hydroxyapatite with or without Bone Marrow Aspiration from Vertebral Body in Posterolateral Lumbar Fusion: a Randomized-Controlled Trial. Lampang Medical Journal, 44(2), 48–57. Retrieved from https://he01.tci-thaijo.org/index.php/LMJ/article/view/266506
Original Article


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