Bone Graft Volumetric Changes and Clinical Outcomes After Instrumented Lumbar or Lumbosacral Fusion A Prospective Cohort Study With a Five-Year Follow-up

Prospective cohort study. To determine: (1) patterns of bone graft volumetric changes, (2) whether different fusion methods, numbers of fusion segments, and range of fusion affect bone graft volumetric changes, and (3) whether these changes affect clinical and functional outcomes after surgery. Bone...

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Published in:Spine (Philadelphia, Pa. 1976) Pa. 1976), 2009-07, Vol.34 (16), p.1663-1668
Main Authors: HA, Kee-Yong, LEE, Jun-Seok, KIM, Ki-Won
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description Prospective cohort study. To determine: (1) patterns of bone graft volumetric changes, (2) whether different fusion methods, numbers of fusion segments, and range of fusion affect bone graft volumetric changes, and (3) whether these changes affect clinical and functional outcomes after surgery. Bone graft volumetric change is likely to importantly determine successful fusion. However, despite the importance of graft volumetric changes, little information is available on bone graft volumetric changes after instrumented fusion. Thirty-one patients with lumbosacral disease who underwent decompression and instrumented spinal fusion using autologous iliac bone graft were included in this study. Patients were classified into 3 major categories, based on fusion methods, the number of fusion segments, and range of fusion, namely, (1) the posterolateral fusion and the posterior lumbar interbody fusion groups, (2) the one-segment fusion and 2-segment fusion groups, and (3) the floating fusion (fusion to L5) and fixed fusion (fusion to S1) groups. To evaluate bone graft volumetric changes, computed tomography scans were performed. Group graft volumes were compared, and Oswestry Disability Index and visual analogue scales scores were obtained to evaluate clinical and functional outcomes. Initial graft volumes had decreased by 8% at 6 months and by 26.3% between 6 and 12 months after surgery (P = 0.0025, P = 0.0001, respectively). Mean group bone graft volume losses at 5 years after surgery were not significantly different between the posterolateral fusion and posterior lumbar interbody fusion groups or the floating fusion and fixed fusion groups (P = 0.722, P = 0.076, respectively). However, mean bone graft volume loss was significant greater in the 2-segment fusion group than in the one-segment fusion group (P = 0.007). No statistical difference in visual analogue scales and Oswestry Disability Index score decreases were observed between the groups. Mean graft bone volume loss during 5 years increased with initial graft volume (r = 0.525, P = 0.003). However, ratios of volume loss over 5 years versus initial graft volume decreased with initial graft volume (r = -0.459, P = 0.011). One-third of initial bone grafts were found to be resorbed over 5 years and the majority of this resorption was found to occur between 6 months and 1 year after instrumented lumbar/lumbosacral fusion. Furthermore, bone graft volumetric changes were not affected by fusion methods or ranges o
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To determine: (1) patterns of bone graft volumetric changes, (2) whether different fusion methods, numbers of fusion segments, and range of fusion affect bone graft volumetric changes, and (3) whether these changes affect clinical and functional outcomes after surgery. Bone graft volumetric change is likely to importantly determine successful fusion. However, despite the importance of graft volumetric changes, little information is available on bone graft volumetric changes after instrumented fusion. Thirty-one patients with lumbosacral disease who underwent decompression and instrumented spinal fusion using autologous iliac bone graft were included in this study. Patients were classified into 3 major categories, based on fusion methods, the number of fusion segments, and range of fusion, namely, (1) the posterolateral fusion and the posterior lumbar interbody fusion groups, (2) the one-segment fusion and 2-segment fusion groups, and (3) the floating fusion (fusion to L5) and fixed fusion (fusion to S1) groups. To evaluate bone graft volumetric changes, computed tomography scans were performed. Group graft volumes were compared, and Oswestry Disability Index and visual analogue scales scores were obtained to evaluate clinical and functional outcomes. Initial graft volumes had decreased by 8% at 6 months and by 26.3% between 6 and 12 months after surgery (P = 0.0025, P = 0.0001, respectively). Mean group bone graft volume losses at 5 years after surgery were not significantly different between the posterolateral fusion and posterior lumbar interbody fusion groups or the floating fusion and fixed fusion groups (P = 0.722, P = 0.076, respectively). However, mean bone graft volume loss was significant greater in the 2-segment fusion group than in the one-segment fusion group (P = 0.007). No statistical difference in visual analogue scales and Oswestry Disability Index score decreases were observed between the groups. Mean graft bone volume loss during 5 years increased with initial graft volume (r = 0.525, P = 0.003). However, ratios of volume loss over 5 years versus initial graft volume decreased with initial graft volume (r = -0.459, P = 0.011). One-third of initial bone grafts were found to be resorbed over 5 years and the majority of this resorption was found to occur between 6 months and 1 year after instrumented lumbar/lumbosacral fusion. Furthermore, bone graft volumetric changes were not affected by fusion methods or ranges of fusion, and did not affect clinical or functional outcomes. Although bone graft volume loss was found to increase with initial graft volume, larger bone grafts were found to result in a larger fusion mass.</description><identifier>ISSN: 0362-2436</identifier><identifier>EISSN: 1528-1159</identifier><identifier>DOI: 10.1097/BRS.0b013e3181aacab5</identifier><identifier>PMID: 19561561</identifier><identifier>CODEN: SPINDD</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams &amp; Wilkins</publisher><subject>Aged ; Analysis of Variance ; Biological and medical sciences ; Bone Transplantation - diagnostic imaging ; Bone Transplantation - methods ; Cerebrospinal fluid. Meninges. Spinal cord ; Female ; Follow-Up Studies ; Humans ; Imaging, Three-Dimensional ; Lumbar Vertebrae - physiopathology ; Lumbar Vertebrae - surgery ; Lumbosacral Region - physiopathology ; Lumbosacral Region - surgery ; Male ; Medical sciences ; Middle Aged ; Nervous system (semeiology, syndromes) ; Neurology ; Neurosurgery ; Outcome Assessment (Health Care) - methods ; Pain, Postoperative - diagnosis ; Pain, Postoperative - physiopathology ; Prospective Studies ; Skull, brain, vascular surgery ; Spinal Diseases - physiopathology ; Spinal Diseases - surgery ; Spinal Fusion - instrumentation ; Spinal Fusion - methods ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Time Factors ; Tomography, X-Ray Computed - methods ; Transplantation, Autologous</subject><ispartof>Spine (Philadelphia, Pa. 1976), 2009-07, Vol.34 (16), p.1663-1668</ispartof><rights>2009 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c314t-1343bc5e749f23027c543fc8ded1602c7e34c97c3baeecf72247a3aa597a0f693</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=21770143$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19561561$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>HA, Kee-Yong</creatorcontrib><creatorcontrib>LEE, Jun-Seok</creatorcontrib><creatorcontrib>KIM, Ki-Won</creatorcontrib><title>Bone Graft Volumetric Changes and Clinical Outcomes After Instrumented Lumbar or Lumbosacral Fusion A Prospective Cohort Study With a Five-Year Follow-up</title><title>Spine (Philadelphia, Pa. 1976)</title><addtitle>Spine (Phila Pa 1976)</addtitle><description>Prospective cohort study. To determine: (1) patterns of bone graft volumetric changes, (2) whether different fusion methods, numbers of fusion segments, and range of fusion affect bone graft volumetric changes, and (3) whether these changes affect clinical and functional outcomes after surgery. Bone graft volumetric change is likely to importantly determine successful fusion. However, despite the importance of graft volumetric changes, little information is available on bone graft volumetric changes after instrumented fusion. Thirty-one patients with lumbosacral disease who underwent decompression and instrumented spinal fusion using autologous iliac bone graft were included in this study. Patients were classified into 3 major categories, based on fusion methods, the number of fusion segments, and range of fusion, namely, (1) the posterolateral fusion and the posterior lumbar interbody fusion groups, (2) the one-segment fusion and 2-segment fusion groups, and (3) the floating fusion (fusion to L5) and fixed fusion (fusion to S1) groups. To evaluate bone graft volumetric changes, computed tomography scans were performed. Group graft volumes were compared, and Oswestry Disability Index and visual analogue scales scores were obtained to evaluate clinical and functional outcomes. Initial graft volumes had decreased by 8% at 6 months and by 26.3% between 6 and 12 months after surgery (P = 0.0025, P = 0.0001, respectively). Mean group bone graft volume losses at 5 years after surgery were not significantly different between the posterolateral fusion and posterior lumbar interbody fusion groups or the floating fusion and fixed fusion groups (P = 0.722, P = 0.076, respectively). However, mean bone graft volume loss was significant greater in the 2-segment fusion group than in the one-segment fusion group (P = 0.007). No statistical difference in visual analogue scales and Oswestry Disability Index score decreases were observed between the groups. Mean graft bone volume loss during 5 years increased with initial graft volume (r = 0.525, P = 0.003). However, ratios of volume loss over 5 years versus initial graft volume decreased with initial graft volume (r = -0.459, P = 0.011). One-third of initial bone grafts were found to be resorbed over 5 years and the majority of this resorption was found to occur between 6 months and 1 year after instrumented lumbar/lumbosacral fusion. Furthermore, bone graft volumetric changes were not affected by fusion methods or ranges of fusion, and did not affect clinical or functional outcomes. Although bone graft volume loss was found to increase with initial graft volume, larger bone grafts were found to result in a larger fusion mass.</description><subject>Aged</subject><subject>Analysis of Variance</subject><subject>Biological and medical sciences</subject><subject>Bone Transplantation - diagnostic imaging</subject><subject>Bone Transplantation - methods</subject><subject>Cerebrospinal fluid. Meninges. Spinal cord</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Imaging, Three-Dimensional</subject><subject>Lumbar Vertebrae - physiopathology</subject><subject>Lumbar Vertebrae - surgery</subject><subject>Lumbosacral Region - physiopathology</subject><subject>Lumbosacral Region - surgery</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nervous system (semeiology, syndromes)</subject><subject>Neurology</subject><subject>Neurosurgery</subject><subject>Outcome Assessment (Health Care) - methods</subject><subject>Pain, Postoperative - diagnosis</subject><subject>Pain, Postoperative - physiopathology</subject><subject>Prospective Studies</subject><subject>Skull, brain, vascular surgery</subject><subject>Spinal Diseases - physiopathology</subject><subject>Spinal Diseases - surgery</subject><subject>Spinal Fusion - instrumentation</subject><subject>Spinal Fusion - methods</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Time Factors</subject><subject>Tomography, X-Ray Computed - methods</subject><subject>Transplantation, Autologous</subject><issn>0362-2436</issn><issn>1528-1159</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><recordid>eNpdkdtqFEEQhhtRzCb6BiJ9I15N7OP0zuVmcJPAQsR4wKuhpqfGbZmZ3vRByaP4trZmURAKqqj6_iq6f0JecHbOWWPeXLy_PWc94xIlX3MAC71-RFZci3XFuW4ekxWTtaiEkvUJOY3xG2Oslrx5Sk54o2teYkV-XvgF6WWAMdFPfsozpuAsbfewfMVIYRloO7nFWZjoTU7Wz6W7GRMGer3EFIpgSTjQXZ57CNSHP5WPYENRbHN0fqEb-i74eECb3Hekrd_7kOhtysM9_ezSngLdlkH1BcuGrZ8m_6PKh2fkyQhTxOfHfEY-bt9-aK-q3c3ldbvZVVZylSouleytRqOaUUgmjNVKjnY94MBrJqxBqWxjrOwB0Y5GCGVAAujGABvrRp6R1w97D8HfZYypm120OE2woM-xM1Ixreu6LqR6IG15TQw4dofgZgj3HWfdb0-64kn3vydF9vJ4IPczDv9ERxMK8OoIQCz_PAZYrIt_OcGNYVxJ-Qul65iE</recordid><startdate>20090715</startdate><enddate>20090715</enddate><creator>HA, Kee-Yong</creator><creator>LEE, Jun-Seok</creator><creator>KIM, Ki-Won</creator><general>Lippincott Williams &amp; Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20090715</creationdate><title>Bone Graft Volumetric Changes and Clinical Outcomes After Instrumented Lumbar or Lumbosacral Fusion A Prospective Cohort Study With a Five-Year Follow-up</title><author>HA, Kee-Yong ; LEE, Jun-Seok ; KIM, Ki-Won</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c314t-1343bc5e749f23027c543fc8ded1602c7e34c97c3baeecf72247a3aa597a0f693</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Aged</topic><topic>Analysis of Variance</topic><topic>Biological and medical sciences</topic><topic>Bone Transplantation - diagnostic imaging</topic><topic>Bone Transplantation - methods</topic><topic>Cerebrospinal fluid. Meninges. Spinal cord</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Imaging, Three-Dimensional</topic><topic>Lumbar Vertebrae - physiopathology</topic><topic>Lumbar Vertebrae - surgery</topic><topic>Lumbosacral Region - physiopathology</topic><topic>Lumbosacral Region - surgery</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Nervous system (semeiology, syndromes)</topic><topic>Neurology</topic><topic>Neurosurgery</topic><topic>Outcome Assessment (Health Care) - methods</topic><topic>Pain, Postoperative - diagnosis</topic><topic>Pain, Postoperative - physiopathology</topic><topic>Prospective Studies</topic><topic>Skull, brain, vascular surgery</topic><topic>Spinal Diseases - physiopathology</topic><topic>Spinal Diseases - surgery</topic><topic>Spinal Fusion - instrumentation</topic><topic>Spinal Fusion - methods</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Time Factors</topic><topic>Tomography, X-Ray Computed - methods</topic><topic>Transplantation, Autologous</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>HA, Kee-Yong</creatorcontrib><creatorcontrib>LEE, Jun-Seok</creatorcontrib><creatorcontrib>KIM, Ki-Won</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Spine (Philadelphia, Pa. 1976)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>HA, Kee-Yong</au><au>LEE, Jun-Seok</au><au>KIM, Ki-Won</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Bone Graft Volumetric Changes and Clinical Outcomes After Instrumented Lumbar or Lumbosacral Fusion A Prospective Cohort Study With a Five-Year Follow-up</atitle><jtitle>Spine (Philadelphia, Pa. 1976)</jtitle><addtitle>Spine (Phila Pa 1976)</addtitle><date>2009-07-15</date><risdate>2009</risdate><volume>34</volume><issue>16</issue><spage>1663</spage><epage>1668</epage><pages>1663-1668</pages><issn>0362-2436</issn><eissn>1528-1159</eissn><coden>SPINDD</coden><abstract>Prospective cohort study. To determine: (1) patterns of bone graft volumetric changes, (2) whether different fusion methods, numbers of fusion segments, and range of fusion affect bone graft volumetric changes, and (3) whether these changes affect clinical and functional outcomes after surgery. Bone graft volumetric change is likely to importantly determine successful fusion. However, despite the importance of graft volumetric changes, little information is available on bone graft volumetric changes after instrumented fusion. Thirty-one patients with lumbosacral disease who underwent decompression and instrumented spinal fusion using autologous iliac bone graft were included in this study. Patients were classified into 3 major categories, based on fusion methods, the number of fusion segments, and range of fusion, namely, (1) the posterolateral fusion and the posterior lumbar interbody fusion groups, (2) the one-segment fusion and 2-segment fusion groups, and (3) the floating fusion (fusion to L5) and fixed fusion (fusion to S1) groups. To evaluate bone graft volumetric changes, computed tomography scans were performed. Group graft volumes were compared, and Oswestry Disability Index and visual analogue scales scores were obtained to evaluate clinical and functional outcomes. Initial graft volumes had decreased by 8% at 6 months and by 26.3% between 6 and 12 months after surgery (P = 0.0025, P = 0.0001, respectively). Mean group bone graft volume losses at 5 years after surgery were not significantly different between the posterolateral fusion and posterior lumbar interbody fusion groups or the floating fusion and fixed fusion groups (P = 0.722, P = 0.076, respectively). However, mean bone graft volume loss was significant greater in the 2-segment fusion group than in the one-segment fusion group (P = 0.007). No statistical difference in visual analogue scales and Oswestry Disability Index score decreases were observed between the groups. Mean graft bone volume loss during 5 years increased with initial graft volume (r = 0.525, P = 0.003). However, ratios of volume loss over 5 years versus initial graft volume decreased with initial graft volume (r = -0.459, P = 0.011). One-third of initial bone grafts were found to be resorbed over 5 years and the majority of this resorption was found to occur between 6 months and 1 year after instrumented lumbar/lumbosacral fusion. Furthermore, bone graft volumetric changes were not affected by fusion methods or ranges of fusion, and did not affect clinical or functional outcomes. Although bone graft volume loss was found to increase with initial graft volume, larger bone grafts were found to result in a larger fusion mass.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams &amp; Wilkins</pub><pmid>19561561</pmid><doi>10.1097/BRS.0b013e3181aacab5</doi><tpages>6</tpages></addata></record>
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subjects Aged
Analysis of Variance
Biological and medical sciences
Bone Transplantation - diagnostic imaging
Bone Transplantation - methods
Cerebrospinal fluid. Meninges. Spinal cord
Female
Follow-Up Studies
Humans
Imaging, Three-Dimensional
Lumbar Vertebrae - physiopathology
Lumbar Vertebrae - surgery
Lumbosacral Region - physiopathology
Lumbosacral Region - surgery
Male
Medical sciences
Middle Aged
Nervous system (semeiology, syndromes)
Neurology
Neurosurgery
Outcome Assessment (Health Care) - methods
Pain, Postoperative - diagnosis
Pain, Postoperative - physiopathology
Prospective Studies
Skull, brain, vascular surgery
Spinal Diseases - physiopathology
Spinal Diseases - surgery
Spinal Fusion - instrumentation
Spinal Fusion - methods
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Time Factors
Tomography, X-Ray Computed - methods
Transplantation, Autologous
title Bone Graft Volumetric Changes and Clinical Outcomes After Instrumented Lumbar or Lumbosacral Fusion A Prospective Cohort Study With a Five-Year Follow-up
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