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Use of biphasic calcium phosphate versus demineralized bone matrix: retrospective clinical and CT analysis of posterolateral fusion results

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Abstract

Purpose

Bone graft extenders have been developed to prevent donor site morbidity associated with iliac crest bone graft, but few studies compared the efficacy of various substitutes. Our purpose was to determine fusion rate and clinical outcome in patients undergoing lumbar arthrodesis using demineralized bone matrix (DBM) and biphasic calcium phosphate (BCP).

Methods

Patients with degenerative spondylolisthesis undergoing one-level or two-level arthrodesis of lumbar spine were retrospectively reviewed. Two treatment groups placed either BCP or DBM, in addition to local autograft in lumbar posterolateral space. Three-dimensional CT exam and dynamic flexion–extension radiographs at postoperative 2-year were assessed for posterolateral fusion status and pain scale and Oswestry Disability Index (ODI) for clinical outcome.

Results

Of the 148 patients reviewed (including 23 in one- and 58 patients in two-level in BCP group, and 47 in one- and 20 patients in two-level in DBM group), no significant differences were found in terms of age, sex, BMI, smoking, diabetes, steroids, number of level fused, non-union rate or revision surgery between BCP and DBM groups. Significantly improved pain scale of back and leg and ODI were found in both groups postoperatively without group difference. We found a comparable fusion rate in one-level surgery (100% versus 93.6%) and a superior fusion rate of BCP group in two-level surgery (98.3% versus 80.0%, p = 0.01).

Conclusion

Being a bone graft extender without osteoinductive property, with local autograft, BCP is comparable to DBM for one- and superior for two-level fusion. No significant difference was found in clinical outcomes.

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Data availability

The datasets generated during and/or analysed during the current study are available in the electronic supplementary material.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, New Taipei Municipal Tucheng Hospital (Built and Operated by Chang Gung Medical Foundation), No. 6, Sec. 2, Jincheng Rd., Tucheng Dist., New Taipei City, 236, Taiwan, Republic of China

    Chi-An Luo & Wen-Chien Chen

  2. Bone and Joint Research Center, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, Republic of China

    Chi-An Luo, Meng-Ling Lu, Ping-Yeh Chiu & Chi-Chien Niu

  3. Chang Gung University College of Medicine, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 333, Taiwan, Republic of China

    Chi-An Luo, Wen-Chien Chen, Meng-Ling Lu, Ping-Yeh Chiu, Chen-Ju Fu & Chi-Chien Niu

  4. Department of Orthopaedic Surgery, Spine Division, Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Rd., Niaosong Dist., Kaohsiung City, 833, Taiwan, Republic of China

    Meng-Ling Lu

  5. Department of Orthopaedic Surgery, Spine Division, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, Republic of China

    Ping-Yeh Chiu & Chi-Chien Niu

  6. Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, Republic of China

    Chen-Ju Fu

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Correspondence to Chi-Chien Niu.

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The authors declare that they have no competing interests.

Ethical approval

Ethical review committee statement: this retrospective study with Ref. No. 201901144B0 was approved with informed consent waiver by the Chang Gung Memorial Hospital Institutional Review Board (CGMH IRB, Linkou, Taiwan).

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Luo, CA., Chen, WC., Lu, ML. et al. Use of biphasic calcium phosphate versus demineralized bone matrix: retrospective clinical and CT analysis of posterolateral fusion results. Eur Spine J 32, 734–742 (2023). https://doi.org/10.1007/s00586-022-07499-y

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