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As a result, numerous alternatives to autograft bone, including allogeneic bone, have emerged with the goal of facilitating bone formation while limiting the inherent drawbacks of autograft.Īmong these allogeneic alternatives, cellular bone allografts (CBAs) are a relatively new class of bone void filler that are designed to preserve viable osteogenic cells within an osteoconductive corticocancellous bone matrix and also contain demineralized bone to enhance osteoinductivity.
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Local bone from the primary surgical site is another common graft option, but its available volume is limited, and it remains, on its own, subject to the same patient-related limitations as ICBG. Further, the additional surgical procedure to harvest ICBG increases operative time and blood loss, with subsequent increases in cost and postoperative pain. However, its quality is inherently limited by patient age, comorbidities, and lifestyle risk factors. Autologous bone, such as iliac crest bone graft (ICBG), is the traditionally-preferred source of these properties. Successful bone fusion requires three main properties: an osteoconductive scaffold to support it, osteoinductive molecular signals to promote it, and osteogenic cells to facilitate it. Although generally successful, IPLF/TLIF surgeries are known to be negatively affected by certain patient comorbidities and lifestyle risk factors, such as obesity and smoking, which can slow or prevent fusion. In recent years, some studies have found improved fusion and functional outcomes with the addition of interbody devices, such as with transforaminal interbody fusion (TLIF), leading to their increased use. Instrumented posterior lumbar fusion (IPLF) is one such surgical procedure often performed for spondylolisthesis, degenerative lumbar disc, and facet arthropathy. While some patients find relief from noninvasive interventions, spine surgery may be indicated when these treatments are not successful. Low back pain is among the most prevalent medical complaints across the globe and a leading cause of disability. The results of this study suggest that V-CBA consistently yields successful fusion and significant decreases in patient-reported ODI and VAS, despite patient comorbidities and lifestyle risk factors that are known to negatively affect such bony healing. Mean postoperative ODI and VAS scores were significantly reduced versus preoperative ratings. Successful fusion was reported in all 6 patients overall with previous pseudarthrosis at the same level. In IPLF+TLIF patients currently using tobacco ( n = 19), fusion was reported in 16 patients (84.3%), while in those with a history of tobacco use ( n = 53), fusion was observed in 48 patients (90.6%).
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Of 22 patients with diabetes in the IPLF+TLIF group, fusion was reported in 20 patients (90.9%). Successful fusion (Lenke A or B) was reported for 88 of 96 patients (91.7%) overall, including in all IPLF-only patients. Resultsĭata from 96 patients were assessed with a total of 222 levels treated overall (mean: 2.3 levels) and a median follow-up time of 16 months (range: 6 to 45 months). Operating room (OR) times and intraoperative blood loss rates were also assessed. Patient-reported clinical outcomes were evaluated via the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for back and leg pain. Radiological outcomes included fusion rates per the Lenke scale. Baseline patient and procedure characteristics were assessed. This was a retrospective study of de-identified data from consecutive patients at an academic medical center who underwent IPLF procedures with or without TLIF, and with V-CBA. The purpose of this study was to assess fusion outcomes in patients undergoing IPLF/TLIF using V-CBA with baseline comorbidities and lifestyle risk factors known to negatively affect bone fusion. An advanced cellular bone allograft (CBA) with viable osteogenic cells (V-CBA) has demonstrated high fusion rates, but the rates for patients with severe and/or multiple comorbidities remain understudied. Certain patient comorbidities and lifestyle risk factors, such as obesity and smoking, are known to negatively affect these procedures.
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Instrumented posterior lumbar fusion (IPLF) with and without transforaminal interbody fusion (TLIF) is a common treatment for low back pain when conservative interventions have failed.