Research ArticleLumbar Spine

High Lumbar Spinal Fusion Rates Using Cellular Bone Allograft Irrespective of Surgical Approach

Todd Lansford, Daniel K. Park, Joshua J. Wind, Pierce Nunley, Timothy A. Peppers, Anthony Russo, Hamid Hassanzadeh, Jonathan Sembrano, Jung Yoo and Jonathan Sales
International Journal of Spine Surgery August 2024, 18 (4) 355-364; DOI: https://doi.org/10.14444/8612

Article Figures & Data

Figures

  • Figure 1
    Figure 1

    Study enrollment. A total of 274 patients were enrolled into the study. Surgical analyses included patients who underwent interbody fusion (ie, anterior, lateral, and posterior surgical approaches). Available data from all timepoints extending through 24 months are reported.

  • Figure 2
    Figure 2

    Successful fusion status by a surgical approach using bridging bone. Overall, a 98.9% successful fusion rate was observed at 24 months. Stratified by surgical approach, a 97.9% successful fusion rate was observed in patients who underwent anterior surgery; 100.0% in patients who underwent lateral surgery; and 98.8% in patients who underwent posterior surgery. Between-group comparisons showed no significant difference of approach on fusion success (P > 0.05).

  • Figure 3
    Figure 3

    Radiographic images showing fusion status at 24 months. (A) Fusion success. (B) Fusion failure.

  • Figure 4
    Figure 4

    Improvement in quality of life EQ5D EQCAL Index Score by surgical approach. A significant improvement in EQ5D was noted in patients who underwent anterior, lateral, and posterior surgery at all timepoints (P < 0.0001). At 12 months, a significant difference between anterior and posterior approaches (P = 0.04) and lateral and posterior approaches (P = 0.0009) was observed. At 24 months, a significant difference between anterior and lateral approaches (P = 0.01) and posterior and lateral approaches (P = 0.0001) was observed.

  • Figure 5
    Figure 5

    Improvement in Oswestry Disability Index (ODI) by surgical approach. A significant improvement in ODI was noted in patients who underwent anterior, lateral, and posterior surgery at all timepoints, P < 0.0001. At 6, 12, and 24 months, a significant difference between lateral and posterior approaches (P < 0.05) was observed.

  • Figure 6
    Figure 6

    Improvement in visual analog scale (VAS) by surgical approach. A significant improvement in VAS scores was noted in patients who underwent anterior, lateral, and posterior surgery at all timepoints, P < 0.0001. A significant difference was observed in VAS back scores between anterior and lateral surgical approaches at the 6 weeks timepoint (P < 0.01).

Tables

  • Table 1

    Patient demographics.

    VariableAnterior
    n = 63 (25%)    		Lateral
    n = 63 (25%)    		Posterior
    n = 126 (50%)    		Overall
    n = 252 (100%)
    Sex, n (%)
     Women36 (57.1)46 (73.0)77 (61.1)159 (63.1)
     Men27 (42.9)17 (27.0)49 (38.9)93 (36.9)
    Ethnicity, n (%)
     Hispanic or Latino4 (6.4)1 (1.6)3 (2.38)8 (3.2)
     Not Hispanic or Latino59 (93.7)62 (98.4)122 (96.8)243 (96.4)
     Unknown0 (0.0)0 (0.0)1 (0.8)1 (0.4)
    Race, n (%)
     Black or African American7 (11.1)10 (15.9)9 (7.1)26 (10.3)
     Other1 (1.6)2 (3.2)5 (4.0)8 (3.2)
     Caucasian or white55 (87.3)51 (81.0)112 (88.9)218 (86.5)
    Work Status, n (%)
     Full time30 (47.6)17 (27.0)49 (38.9)96 (38.1)
     Part time3 (4.8)3 (4.8)14 (11.1)20 (7.9)
     Not working30 (47.6)43 (68.3)63 (50.0)136 (54.0)
    Age, y
     Mean (SD)55.0 (13.9)63.5 (9.7)57.4 (12.2)58.3 (12.5)
     Min–max19–7641–8224–8219–82
    Height, cm
     Mean (SD)170.9 (9.5)164.2 (11.1)169.1 (9.5)168.3 (10.2)
     Min–max152.4–200.7132.1–195.6149.9–190.5132.1–200.7
    Weight, kg
     Mean (SD)87.52 (20.7)87.31 (19.5)87.19 (20.1)87.30 (20.0)
     Min–max45.4–163.349.0–122.941.7–131.541.7–163.3
    BMI, kg/m2
     Mean (SD)29.9 (6.2)32.4 (6.8)30.4 (6.5)30.8 (6.5)
     Min–max18.5–51.418.0–44.918.0–46.518.0–51.4
    Nicotine Use, n (%)
     Smoker10 (15.9)17 (27.0)20 (15.9)47 (18.7)
     Nonsmoker53 (84.1)46 (73.0)106 (84.1)205 (81.4)
    Osteoporosis, n (%)
     Osteoporosis2 (3.2)8 (12.7)6 (4.8)16 (6.4)
     No osteoporosis61 (96.8)55 (87.3)120 (95.2)236 (93.7)

    • Abbreviation: BMI, body mass index.

  • Table 2

    Surgical approach and number of levels treated.

    No. of Levels TreatedOverall
    n = 252 (100%)
    n (%)    		Anterior
    n = 63 (25%)
    n (%)    		Lateral
    n = 63 (25%)
    n (%)    		Posterior
    n = 126 (50%)
    n (%)
    1 Level189 (75.0)39 (61.9)46 (73.0)104 (82.5)
    2 Levels61 (24.2)22 (34.9)17 (27.0)22 (17.5)
    3 Levels2 (0.8)2 (3.2)0 (0.0)0 (0.0)
  • Table 3

    Fusion status success.

    Surgical ApproachSuccessful Fusion
    Bridging Bone
    n (%)    		QMA
    n (%)    		Bridging Bone + QMAa
    n (%)
    12 Mo (n = 205)
     Overall fusion success202 (98.5)189 (92.2)187 (91.2)
     By approach
      Anterior (n = 53)52 (98.1)45 (84.9)44 (83.0)
      Lateral (n = 56)56 (100.0)53 (94.6)53 (94.6)
      Posterior (n = 96)94 (97.9)91 (94.7)90 (93.8)
    24 Mo (n = 184)
     Overall fusion success182 (98.9)170 (92.4)169 (91.8)
     By approach
      Anterior (n = 48)47 (97.9)42 (87.5)41 (85.4)
      Lateral (n = 51)51 (100.0)48 (94.1)49 (96.1)
      Posterior (n = 85)84 (98.8)80 (94.1)79 (92.9)

    • Abbreviation: QMA, quantitative motion analysis.

    • Note: Numbers reported for bridging bone, QMA, and bridging bone plus QMA are only for patients with successful fusion.

    • ↵a No statistically significant difference was observed between surgical approaches at 12 and 24 months.

  • Table 4

    Surgical fusion type.

    CBA + Local BoneSuccessful Fusion, n/N (%)
    Lateral—interbody64/67 (95.5)
    Posterior—interbody3/3 (100.0)

    • Abbreviation: CBA, cellular bone allograft.

  • Table 5

    Adverse events by surgical approach.

    Adverse Events TermSeriousRelatednessSeveritySurgical Approach
    Radiculopathy L5–S1 distributionYesDefinitely relatedSeverePosterior
    Surgery; lami fusion L4/5 and L5/S1YesProbably relatedSevereAnterior
    Back pain with sciaticaNoProbably relatedSevereAnterior
    SwellingNoPossibly relatedModerateAnterior
    Increased numbnessNoPossibly relatedModerateAnterior
    Worsening foraminal stenosisNoPossibly relatedModerateAnterior
    Postoperative neuritisNoPossibly relatedModerateAnterior
    TinglingNoPossibly relatedMildAnterior
    NumbnessNoProbably relatedMildAnterior
    PainNoPossibly relatedModerateLateral
    Increased spondylosisNoPossibly relatedMildLateral
    Increased spondylolisthesNoPossibly relatedMildLateral
    Increased back painNoPossibly relatedModerateLateral
    PainNoPossibly relatedModerateLateral

    • Note: Adverse events may present from the same patient.

    • a There were a total of 14 adverse events: 8 (57.1%) in the anterior group, 5 (35.7%) in the lateral group, and 1 (7.1%) in the posterior group.

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High Lumbar Spinal Fusion Rates Using Cellular Bone Allograft Irrespective of Surgical Approach
Todd Lansford, Daniel K. Park, Joshua J. Wind, Pierce Nunley, Timothy A. Peppers, Anthony Russo, Hamid Hassanzadeh, Jonathan Sembrano, Jung Yoo, Jonathan Sales
International Journal of Spine Surgery Aug 2024, 18 (4) 355-364; DOI: 10.14444/8612
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