Di. Alexander et al., Efficacy of calcium sulfate plus decompression bone in lumbar and lumbosacral spinal fusion: preliminary results in 40 patients, CAN J SURG, 44(4), 2001, pp. 262-266
Objective: To compare the efficacy of calcium sulfate pellets plus bone obt
ained from decompression with fresh autologous iliac crest bone in lumbar a
nd lumbosacral spinal fusion with decompression. Design: A prospective rand
omized clinical trial. Setting: Four tertiary care centres in Halifax, NS.
Patients: All were consenting, skeletally mature and suffering from degener
ative disc disease or spondylolisthesis. The first 40 patients from a singl
e test centre are reported; 32 of these had completed I-year follow-up. Int
erventions: Posterolateral lumbar or lumbosacral spinal fusion with spinal
canal decompression and randomized placement of test material (decompressio
n bone plus an equal volume of calcium sulfate pellets) on one side and con
trol material (autologous posterior iliac crest bone of equal volume to the
test material) on the contralateral side, which allowed subjects to act as
their own control. Outcome measures: Assessment of bone formation by radio
graphic evaluation at 6 and 12 months after fusion by an independent muscul
oskeletal radiologist blinded to the placement of test material. Results. A
t 6 and 12 months after fusion, 78% and 88% of patients, respectively, show
ed bone formation at the test site that was 75% to 100% of, equal to or mor
e than that at the control site. Increases in bone formation at 6 and 12 mo
nths were almost identical at both sites. Smoking status, patient gender or
age, instrumentation used and volume of graft used were not predictive of
outcome. Conclusions: Calcium sulfate pellets plus decompression bone provi
ded bone formation equivalent to autologous iliac crest bone in a majority
of patients. Calcium sulfate pellets plus decompression bone may provide a
viable alternative to autologous iliac crest as a graft material for spinal
fusion.