Article Figures & Data
Figures
- Fig. 1
CT Classification of Spinal Fusion. 0 – No bony ingrowth; 1 – Cranial downgrowth or caudal upgrowth; 2 – Cranial downgrowth and caudal upgrowth but NOT bridging; 3 – Complete bridging trabecular bone fusion; A – No evidence of supplemental fixation failure/no halo seen; B – Evidence of supplemental fixation failure/halo seen.
- Fig. 2
Representative example of 2A fusion status
- Fig. 3
Representative example of 3A fusion status.
- Fig. 4
One-level fusion status.
- Fig. 5
Two-level fusion status by patient.
- Fig. 6
Two-level fusion status by level.
- Fig. 7
One-Level Clinical Outcomes preoperative and postoperative. Error Bars show standard deviation from the mean.
- Fig. 8
Two-Level Clinical Outcomes preoperative and postoperative. Error Bars show standard deviation from the mean.
Tables
Demographic One-Level Two-Level N (No.) 38 34 Age (Mean ± SD) 58.4 ±12.7 49.3±10.9 BMI (Mean ± SD) 30.6±6.08 30.1±5.82 Male (%) 11 (28.9) 14 (41.2) Female (%) 27 (71.1) 20 (58.8) One-Level Levels Treated No. Patients L1-L2 1 L2-L3 1 L3-L4 6 L4-L5 20 L5-S1 10 Two-Level Levels Treated No. Patients L2-L4 1 L3-L5 9 L4-S1 24 CT Fusion Status Approach 1 2A 3A Total Levels ALIF 0 11 53 64 LLIF 0 7 23 30 TLIF 1 2 9 12 No. of Comorbidities Comorbidities One-Level Two-Level None N/A 4 (10.5%) 4 (11.8%) Total of Patients with No Comorbidities 4 (10.5%) 4 (11.8%) One Overweight 3 (7.9%) 6 (17.6%) Obese 4 (10.5%) 11 (32.4%) PLS 2 (5.3%) 0 (0.0%) Smoking 0 (0.0%) 3 (8.8%) Total of Patients with One-Comorbidity 9 (23.7%) 20 (58.8%) Two Smoking / PLS 1 (2.6%) 0 (0.0%) Overweight / PLS 5 (13.2%) 1 (2.9%) Overweight / Smoking 1 (2.6%) 2 (5.9%) Overweight / Diabetes 1 (2.6%) 1 (2.9%) Obese / Smoking 5 (13.2%) 2 (5.9%) Obese / Diabetes 3 (7.9%) 2 (5.9%) Total of Patients with Two-Comorbidities 16 (42.1%) 8 (23.5%) Three Overweight / Smoking / PLS 1 (2.6%) 0 (0.0%) Overweight / Diabetes / PLS 1 (2.6%) 0 (0.0%) Obese / Smoking / Diabetes 1 (2.6%) 0 (0.0%) Obese / Diabetes / PLS 4 (10.5%) 1 (2.9%) Obese / Smoking / PLS 2 (5.3%) 1 (2.9%) Total of Patients with Three Comorbidities 9 (23.7%) 2 (5.9%) Author Evaluation of Fusion Graft Material Comorbidities Time Fusion Rate Dimar et al. (2006)32 CT: Solid Unilateral or bilateral fusion rhBMP-2/CRM Workers comp – 13.2%
Spinal litigation- 3.8%
Smoking- 32.1%12 months 90.6% ICBG Workers comp -17.8%
Spinal litigation -15.6%
Smoking - 22.2%12 months 73.3% Jenis and Banco (2010)37 CT: Graft consolidation on a least 2 contiguous cuts and in at least 2 of 3 planes Silicate-substituted calcium phosphate (Actifuse, Baxter) Smoking-9.5%
Diabetics- 9.5%12 months 76.2% Nagineni etal. (2012)36 CT: Graft consolidation on a least 2 contiguous cuts and in at least 2 of 3 planes Silicate-substituted calcium phosphate (Actifuse, Baxter) Smoking – 11% ∼12 months 80% (Lumbaronly) Nandyala etal. (2014)38 CT: Presence of bridging trabecular bone on at least 2 consecutive coronal and sagittal images, blurring of the bone-graft endplate junction, and absence of radiologic cleft within fusion mass A Silicate-substituted calcium phosphate (Actifuse, Baxter) Workers comp –38.5%
Smoking – 30.8%12 months 65.4% rhBMP-2 (INFUSE, Medtronic, Inc.) Workers comp –26.9%
Smoking – 26.9%12 months 92.3% Roh et al. (2013)39 Radiograph: Presence of bridging bone across endplates or from endplates to interspace disc plugs rhBMP-2 (INFUSE, Medtronic, Inc.) Not available 12 months 83.5% Allogenic Morphogenic protein (OsteoAMP, Advanced Biologics) Not available 12 months 93.3% Park et al (2013)33 CT: Presence of bridging trabecular bone on at least 2 images and cortication of the peripheral edges of the fusion mass rhBMP-2 (INFUSE, Medtronic) with LBG Not available 12 months 85.7% rhBMP-2 (INFUSE, Medtronic) with ICBG Not available 12 months 83.4% Malham, etal. (2014)26 CT: Presence of bridging trabecular bone rhBMP-2 (INFUSE, Medtronic, Inc.) Smoking-9.2%
Diabetes-2.3%
Hypertension-7.6%
Depression-3.8%
Prior lumbar surgery-14.5%12 months 96.5% ALIF
97.8 HybridAmmerman,et al. (2013)17 If patient asymptomatic: Radiographic evidence of bridging bone with no motion – 100% of patients evaluated with radiograph
or
If patient symptomatic: CT evidence of bridging boneAllograft cellular bone matrix containing mesenchymal stem cells (MSCs) and osteoprogenitor cells combined with DBM and cancellous bone (Osteocel Plus, Nuvasive) Osteoporosis - 4.3%
Diabetes - 13.0%
Smoking - 4.3%
Chronic steroid use -4.3%12 months 92.3% Tohmeh et al. (2012)40 Fluoroscopy-guided radiography (FGX)- 98% of patients evaluated with FGX
or
CT: Complete ossification with some component of endplate involvement. – One patient (3%) was evaluated with CTAllograft cellular bone matrix containing mesenchymal stem cells (MSCs) and osteoprogenitor cells combined with DBM and cancellous bone (Osteocel Plus, Nuvasive) Tobacco use - 12.5%
Coronary ArteryDisease - 47.5%
Diabetes - 20%
COPD - 5%
Steroid use - 8% Any prior spinesurgery - 65% Any prior spinesurgery - 65%12 months 90.20% Sardar, etal. (2015)19 Based on Medical Metrics Inc. (Houston, Texas) criteria using CT and radiographs:
Evidence of bridging bone
Less than 50% radiolucency
Less than 5 degrees of motion and less than 3 mm translationB2A peptide (Prefix 150, BioSET, Inc) Not available 12 months 50% B2A peptide (Prefix 750, BioSET, Inc) Not available 12 months 100% ICBG Not available 12 months 77.80% Lauweryns,et al. (2015)34 CT: Presence of bridging trabecular bone ABM/P-15 (i-FACTOR, Cerpedics, Inc.)* BMI 25-30 - 40%
BMI >30 - 20%
Tobacco use - 27.5%
Diabetes - 12.5%12 months 97.78% ABG 12 months 82.22% Thaler et al. (2013)41 Radiograph: Bony bridging, bony continuity between endplate, trabecular structure in anterior bone and lack of radiolucent lines
CT: 30% of endplate to endplate bridging anteriorly. Continuous intersegmental bridging in posterior column.β – TCP (Chronos, Synthes) Smoking – 32.4% Previous lumbar surgery adjacent to index level – 23.5% 12 months Radiographic– 47.7%
CT – 61.4%Berjano,etal. (2015)35 CT: Evidence of bridging trabecular bone from lower endplate to upper endplate Synthetic bone graft comprised of calcium phosphate granules and hydroxyapatite (Attrax,Nuvasive) Not available 12 months 83% Nanocrystals -nanohydroxyapatite-based bone graft substitute (Nanostim, Medtronic) Not available 12 months 100% ABG Not available 12 months 75% Calcium triphosphate Not available 12 months 89% Kurd et al. (2014)18 CT: Brantigan, Steffee, Fraser method42
Radiographs: < 5 degrees motionOsteconductive - allografts, tri-calcium phosphate (Vitoss, Orthovita, Inc), silicate-substitutedcalcium phosphate (Actifuse, ApaTech), ceramics (Mastergraft, Medtronic), andhydroxyapatite products (nannOss, Pioneer) BMI (mean, SD) -32.5, 7.1
Smoking - 39.2%12 months 93.75% Osteoinductive - rhBMP-2 (Infuse Kit, Medtronic), demineralized bone matrices (GraftonDBM Matrix, Medtronic, Progenix DBM Putty, Medtronic), and stem cell-based products (Osteocel Plus, Nuvasive Inc) BMI (mean, SD): 30.6,6.4
Smoking (%): 36.1%12 months 87.18% ↵* Not available for sale in the USA.
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