• Tsuyoshi Yamada, Toshitaka Yoshii, Shinichi Sotome, Masato Yuasa, Tsuyoshi Kato, Yoshiyasu Arai, Shigenori Kawabata, Shoji Tomizawa, Kyohei Sakaki, Takashi Hirai, Kenichi Shinomiya, and Atsushi Okawa.
• Section of Orthopaedic and Spinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
• Spine. 2012 Feb 1;37(3):E174-9.

Study DesignA prospective, comparative study.ObjectiveWe developed a hybrid graft (HBG) of porous β-tricalcium phosphate ceramics/percutaneously harvested bone sticks/autologous bone marrow aspirate for lumbar posterolateral fusion (PLF). The aim of this study was to investigate the efficacy of the HBG as a substitute for conventional corticocancellous iliac autografts.Summary Of Background DataIliac crest bone graft (ICBG) has been traditionally used as the golden standard for lumbar spinal fusion. The significant complication rate associated with harvesting corticocancellous ICBG, however, has encouraged development of alternative graft substitutes.MethodsFrom September 2005, 61 consecutive patients underwent decompressive laminotomy and 1-level instrumented PLF. Each patient in this study had the constructs of the HBG placed on 1 side of the intertransverse process gutter. An autologous local bone graft (LBG) harvested during decompressive laminotomy was placed on the other side as a control. Radiographic evaluation was performed at 6 months, 1 year after surgery, and subsequently on an annual basis. The fusion statuses on either side of vertebra were compared.ResultsThe flexion-extension motion in the dynamic x-rays at the target level decreased over time. Only 1 case exhibited over 5° of angular motion 2 years after surgery. In the evaluation of fusion status, the fusion rate for the HBG side (68.9% at 6 months, 83.6% at 1 year, 93.5% at 2 years) was higher than that for the LBG side (49.2% at 6 months, 75.4% at 1 year, 89.1% at 2 years) with a significant difference at 6 months after surgery. No significant complications at the donor site were found postoperatively.ConclusionThe HBG promoted posterolateral spinal fusion without significant donor site morbidity. Because of its efficacy and safety, this hybrid construct seems promising as an alternative to conventional iliac bone grafts for lumbar spinal fusion.

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