Bone graft substitute combined with bone marrow aspirate shows efficacy in multi-level cervical fusions

Of 60 patients followed for radiographic fusion, 58 showed successful fusion at 18 months follow-up.

A combination of bone graft substitute and bone marrow aspirate used in conjunction with fibular allograft was effective in promoting fusion in patients who underwent multi-level anterior cervical fusion surgeries, according to a study published in the journal Neurosurgery.

"Although randomized, controlled studies are necessary to determine whether or not the fusion rates are superior to those obtained from using allograft alone, these results compare favorably to historical data in the literature," the study authors wrote.

Paul Khoueir, MD, and colleagues evaluated outcomes for 66 consecutive patients who underwent either multi-level anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), or both procedures.

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Patients averaged 53 years of age. All surgeries were performed between the C3 and T1 levels, according to the study.

In all cases, surgeons performed a Smith-Robinson decompression. This was followed by allograft fibula strut grafting, which was filled with Healos bone graft replacement (collagen-hydroxyapatite matrix, DePuy Spine, a Johnson & Johnson company) and autogenous bone marrow aspirate (BMA). Anterior semiconstrained cervical plating was also used, according to the study.

Including discectomies performed during ACCF procedures, surgeons fused an average of 3.1 levels, ranging from two to five disc levels. Also, 17 patients underwent one- to four-level corpectomies, with an average of two levels treated.

Overall, 60 patients were followed for radiographic fusion. Of these patients, 58 (96.8%) who had ACDF and/or ACCF procedures between two and five disc levels demonstrated successful radiographic fusion at 18 months follow-up, according to the study.

Investigators noted clinical improvements in 49 patients. In nine patients, conditions remained unchanged, and two patients had radicular palsies, the authors reported.

Healos is a bone graft substitute that serves as a 3-dimensional scaffold for use with autologous BMA. Healos is intended for use in filling bony voids or gaps of the skeletal system not intrinsic to the stability of the bony structure and is resorbed and remodeled into new bone as part of the healing process, according to a press release from DePuy Spine.

For more information:

• Khoueir P, Oh BC, DiRisio DJ, et al. Multilevel anterior cervical fusion using a collagen-hydroxyapatite matrix with iliac crest bone marrow aspirate: An eighteen-month follow-up study. Neurosurgery. 2007;61:963-971.