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Preliminary study showing safety/efficacy of nanoss bioactive versus vitoss as bone graft expanders for lumbar noninstrumented fusions.

Epstein NE - Surg Neurol Int (2015)

Bottom Line: Surgery addressed stenosis/ossification of the yellow ligament (OYL) (all patients), with subsets exhibiting degenerative spondylolisthesis synovial cysts, and disc disease.In this preliminary study of patients undergoing multilevel lumbar lamienctomies with posterolateral noninstrumented fusions, results were nearly comparable utilizing Vitoss or NanOss as bone graft expanders.Although the number of NanOss patients was substantially lower, the comparable efficacy and absence of postoperative complications for noninstrumented fusions is promising.

View Article: PubMed Central - PubMed

Affiliation: Chief of Neurosurgical Spine and Education, Department of NeuroScience, Winthrop University Hospital, Mineola, NY 11501, USA.

ABSTRACT

Background: The lateral fusion mass for multilevel lumbar laminectomies with noninstrumented posterolateral fusions now often utilizes lamina autograft and bone marrow aspirate (BMA) mixed with one of two bone graft expanders: either Vitoss (Orthovita, Malvern, PA, USA) or NanOss Bioactive (Regeneration Technologies Corporation: RTI, Alachua, FL, USA).

Methods: Here, we compared two sequential prospective the times to fusion, fusion rates, complications, and infection rates for two prospective cohorts of patients utilizing either Vitoss (first 213 patients) or NanOss (subsequent 45 patients) respectively, undergoing multilevel lumbar laminectomies (average 4.6 vs. 4.5 levels) with noninstrumented fusions (average 1.3 vs. 1.2 levels). Surgery addressed stenosis/ossification of the yellow ligament (OYL) (all patients), with subsets exhibiting degenerative spondylolisthesis synovial cysts, and disc disease. Fusion was documented by two independent neuroradiologists blinded to the study design, utilizing dynamic X-rays and two dimensional computed tomography (2D-CT) studies up to 6 months postoperatively, and up to 1 year where indicated.

Results: Comparison of patients receiving Vitoss versus NanOss as bone graft expanders revealed nearly comparable; times to fusion (5.3 months vs. 4.8 months), fusion rates (210 [98.6%] vs. 45 [100%] patients), pseudarthroses (3 [1.4%] vs. 0), postoperative seromas (2 [0.94%] vs. 0), and deep wound infections (2 [0.94%] vs. 0).

Conclusion: In this preliminary study of patients undergoing multilevel lumbar lamienctomies with posterolateral noninstrumented fusions, results were nearly comparable utilizing Vitoss or NanOss as bone graft expanders. Although the number of NanOss patients was substantially lower, the comparable efficacy and absence of postoperative complications for noninstrumented fusions is promising.

No MeSH data available.


Related in: MedlinePlus

A 73-year-old female underwent a multilevel L2-S1 lumbar laminectomy and noninstrumented L4-5 posterolateral fusion (for grade I degenerative spondylolisthesis) utilizing lamina autograft/BMA/Vitoss. The 6-month postoperative axial CT study demonstrated continuity of the fusion mass consistent with adequate arthrodesis
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Figure 1: A 73-year-old female underwent a multilevel L2-S1 lumbar laminectomy and noninstrumented L4-5 posterolateral fusion (for grade I degenerative spondylolisthesis) utilizing lamina autograft/BMA/Vitoss. The 6-month postoperative axial CT study demonstrated continuity of the fusion mass consistent with adequate arthrodesis

Mentions: Patients in both groups also exhibited comparable; times to fusion; 5.3 months vs. 4.8 months [Figures 1–4 and Table 2]. Despite the much greater number of patients in the Vitoss versus NanOss cohorts, both groups exhibited similar fusion rates; 210 (98.6%) of 213 Vitoss patients fused versus 100% fusion rate for the 45 NanOss patients. However, likely due to the larger number of patients in the Vitoss series, three patients exhibited pseudarthrosis (1.4%), two of whom had developed early wound infections (0.94%), while two others developed postoperative seromas (0.94%) warranting debridement. Alternatively, for the smaller sample of NanOss patients, no pseudarthroses, infections, or seromas were observed.


Preliminary study showing safety/efficacy of nanoss bioactive versus vitoss as bone graft expanders for lumbar noninstrumented fusions.

Epstein NE - Surg Neurol Int (2015)

A 73-year-old female underwent a multilevel L2-S1 lumbar laminectomy and noninstrumented L4-5 posterolateral fusion (for grade I degenerative spondylolisthesis) utilizing lamina autograft/BMA/Vitoss. The 6-month postoperative axial CT study demonstrated continuity of the fusion mass consistent with adequate arthrodesis
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4496830&req=5

Figure 1: A 73-year-old female underwent a multilevel L2-S1 lumbar laminectomy and noninstrumented L4-5 posterolateral fusion (for grade I degenerative spondylolisthesis) utilizing lamina autograft/BMA/Vitoss. The 6-month postoperative axial CT study demonstrated continuity of the fusion mass consistent with adequate arthrodesis
Mentions: Patients in both groups also exhibited comparable; times to fusion; 5.3 months vs. 4.8 months [Figures 1–4 and Table 2]. Despite the much greater number of patients in the Vitoss versus NanOss cohorts, both groups exhibited similar fusion rates; 210 (98.6%) of 213 Vitoss patients fused versus 100% fusion rate for the 45 NanOss patients. However, likely due to the larger number of patients in the Vitoss series, three patients exhibited pseudarthrosis (1.4%), two of whom had developed early wound infections (0.94%), while two others developed postoperative seromas (0.94%) warranting debridement. Alternatively, for the smaller sample of NanOss patients, no pseudarthroses, infections, or seromas were observed.

Bottom Line: Surgery addressed stenosis/ossification of the yellow ligament (OYL) (all patients), with subsets exhibiting degenerative spondylolisthesis synovial cysts, and disc disease.In this preliminary study of patients undergoing multilevel lumbar lamienctomies with posterolateral noninstrumented fusions, results were nearly comparable utilizing Vitoss or NanOss as bone graft expanders.Although the number of NanOss patients was substantially lower, the comparable efficacy and absence of postoperative complications for noninstrumented fusions is promising.

View Article: PubMed Central - PubMed

Affiliation: Chief of Neurosurgical Spine and Education, Department of NeuroScience, Winthrop University Hospital, Mineola, NY 11501, USA.

ABSTRACT

Background: The lateral fusion mass for multilevel lumbar laminectomies with noninstrumented posterolateral fusions now often utilizes lamina autograft and bone marrow aspirate (BMA) mixed with one of two bone graft expanders: either Vitoss (Orthovita, Malvern, PA, USA) or NanOss Bioactive (Regeneration Technologies Corporation: RTI, Alachua, FL, USA).

Methods: Here, we compared two sequential prospective the times to fusion, fusion rates, complications, and infection rates for two prospective cohorts of patients utilizing either Vitoss (first 213 patients) or NanOss (subsequent 45 patients) respectively, undergoing multilevel lumbar laminectomies (average 4.6 vs. 4.5 levels) with noninstrumented fusions (average 1.3 vs. 1.2 levels). Surgery addressed stenosis/ossification of the yellow ligament (OYL) (all patients), with subsets exhibiting degenerative spondylolisthesis synovial cysts, and disc disease. Fusion was documented by two independent neuroradiologists blinded to the study design, utilizing dynamic X-rays and two dimensional computed tomography (2D-CT) studies up to 6 months postoperatively, and up to 1 year where indicated.

Results: Comparison of patients receiving Vitoss versus NanOss as bone graft expanders revealed nearly comparable; times to fusion (5.3 months vs. 4.8 months), fusion rates (210 [98.6%] vs. 45 [100%] patients), pseudarthroses (3 [1.4%] vs. 0), postoperative seromas (2 [0.94%] vs. 0), and deep wound infections (2 [0.94%] vs. 0).

Conclusion: In this preliminary study of patients undergoing multilevel lumbar lamienctomies with posterolateral noninstrumented fusions, results were nearly comparable utilizing Vitoss or NanOss as bone graft expanders. Although the number of NanOss patients was substantially lower, the comparable efficacy and absence of postoperative complications for noninstrumented fusions is promising.

No MeSH data available.


Related in: MedlinePlus