Remodeling of heat-treated cortical bone allografts for posterior lumbar interbody fusion: serial 10-year follow-up
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Remodeling of heat-treated cortical bone allografts for posterior lumbar interbody fusion: serial 10-year follow-up Koichi Muramatsu • Yudo Hachiya • Hiroyuki Izawa • Harumoto Yamada
Received: 15 April 2011 / Accepted: 9 July 2011 / Published online: 20 July 2011 Ó Springer Science+Business Media B.V. 2011
Abstract We have selected heat-treated bone allografts as the graft material since the Tokai Bone Bank, the first regional bone bank in Japan, was established in 1992. In this study, we examined changes in bone mineral density (BMD), and morphology observed by magnetic resonance imaging (MRI), and histological findings of bone grafts in cases followed up for 7–10 years after bone grafting to grasp the remodeling of heat-treated cortical bone allografts for posterior lumber interbody fusion (PLIF). BMD of bone grafts was reduced by half at 10 years after grafting. MRI revealed that bone grafts were indistinguishable initially in only 22.2% of cases, whereas after a lengthy period of 10 years distinguishable in many cases. Histologically, new bone formation at the graft-host interface was observed earlier, at 1 year after grafting, than that at the periphery of canals in the specimens. The laminated structure of the cortical bone eroded over time, and fragmented bone trabeculae were observed in the specimens at 8 years or longer after grafting, though necrotic bone still remained in some sites. K. Muramatsu (&) Y. Hachiya H. Izawa Hachiya Orthopaedic Hospital, 2-4 Suemori-dori, Chikusa-ku, Nagoya-shi, Aichi 464-0821, Japan e-mail: [email protected] H. Yamada Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
Keywords Bone allograft Posterior lumber interbody fusion Remodeling Heat treatment Bone mineral density Magnetic resonance imaging
Introduction In Japan, allogenic bone grafting in orthopedic surgery is not commonly performed because medical transplantation system has not been sufficiently established. However, allogenic bones with conductivity and inductivity, which need not be obtained during surgery, are considered to be one of hopeful graft materials for future remodeling. Since the Tokai Bone Bank, the first regional bone bank in Japan, was established in 1992 (Hachiya et al. 1999) we have used bone allografts as an option of graft materials for posterior lumber interbody fusion (PLIF). Bone grafts were prepared by cutting the cortical bone of a femoral shaft segment into two (the half of femoral cortical allograft ring: HFCAR), and then by filling autogenous bone chips obtained locally from the operative site into the concave area of the HFCAR (Fig. 1). Local autogenous bones were used to promote early bone union, and cortical bone allografts were used as strong interbody support columns, which was based on the similar concept of metallic or carbon fiber cages (Brantigan et al. 1994). In fact, cortical bone allografts may be superior to these cages in that
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Fig. 1 Bone grafts were
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