Relationship between area ratio of interbody autograft and intervertebral fusion rate

doi:10.12307/2021.349

Abstract

Abstract: BACKGROUND: At present, it is considered that the volume of intervertebral bone graft is one of the factors affecting the intervertebral fusion rate, but the same volume of intervertebral bone graft leads to different release area of intervertebral bone graft and endplate due to individual differences, and the impact of release area of intervertebral bone graft and endplate on the intervertebral fusion rate is rarely analyzed.
OBJECTIVE: To investigate the effect of area ratio of interbody autograft on intervertebral fusion rate during posterior lumbar interbody fusion.
METHODS: Clinical data of 93 patients who underwent posterior lumbar interbody fusion in Department of Spinal Surgery, Affiliated Hospital of Southwest Medical University from January 2017 to December 2018 were retrospectively analyzed. The preoperative intervertebral space height, upper and lower endplate area, Oswestry disability index and visual analogue scale score, Cage size and the amount of autologous bone, and area of autologous bone graft (the area of autologous bone contacting the upper and lower endplates) were recorded, and the average value was calculated. According to the percentage of autogenous bone graft area in the total endplate area measured one week after operation, they were divided into group A (area ratio of interbody autograft < 16%), group B (16% ≤ area ratio of interbody autograft ≤ 24%) and group C (area ratio of interbody autograft > 24%). X-ray and CT examinations were performed at 6 and 12 months and the last follow-up. The direction of cage placement was observed in the three groups. The height of intervertebral space, the area ratio of intervertebral autograft bone graft, brantigan score, Oswestry disability index and visual analogue scale score were recorded at the follow-up. The measurement was performed by two spine surgeons, and repeated at an interval of one week to test inter observer and intra observer reliability. The effect of the area of autologous bone graft on the intervertebral fusion rate was compared and analyzed.
RESULTS AND CONCLUSION: (1) The inter observer and intra observer reliabilities were 0.924 and 0.913, respectively. (2) All patients were followed up for more than 12 months. There were no significant differences in age, gender and surgical segment among the three groups (P > 0.05). There were no significant differences in preoperative intervertebral height, Oswestry disability index and visual analogue scale score among the three groups (P > 0.05). (3) There were 27 cases in group A, including 26 cases of oblique placement and 1 case of transverse placement, 32 cases in group B, including 2 cases of oblique placement and 30 cases of transverse placement, 34 cases in group C, 1 case of oblique placement and 33 cases of transverse placement. (4) There was no significant difference in the amount of intraoperative autologous bone extraction among the three groups (P > 0.05), and the average height of intervertebral space in group A was higher than that in group B and group C one week after operation (P=0.022, P=0.00). The area of autogenous bone graft in group A was smaller than that in group B and group C (P=0.000, P=0.000). (5) At 6 and 12 months after operation, the fusion rate in group A (70.4%, 88.9%) was lower than that in group B (84.4%, 100%) and group C (88.2%, 100%), and the Brantigan score in group A was lower than that in group B (P=0.027, P=0.020) and group C (P=0.018, P=0.001). (6) At the last follow-up, there was no significant difference in Oswestry disability index and visual analogue scale score among the three groups (P > 0.314). The height loss of intervertebral space in group A was greater than that in group B and group C (P=0.007, P=0.013). The increased area of intervertebral fusion in group A was lower than that in group B and group C (P=0.003, P=0.000). There was no significant difference in fusion rate and Brantigan score among groups A, B and C (P=0.902, P=0.712). (7) It is suggested that the percentage of an area ratio of interbody autograft in the total endplate area greater than or equal to 16% can effectively improve the interbody fusion rate and reduce the risk of late intervertebral space collapse.

Key words: lumbar spine, posterior interbody fusion, autogenous bone, bone graft area, fusion rate, unilateral interlaminar fenestration

CLC Number:

Tang Qiang, Zhong Dejun, Wang Qing, Liao Yehui, Tang Chao, Ma Fei. Relationship between area ratio of interbody autograft and intervertebral fusion rate[J]. Chinese Journal of Tissue Engineering Research, 2021, 25(36): 5821-5826.

Figures/Tables 8

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