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Transforaminal lumbar interbody fusion rates in patients using a novel titanium implant and demineralized cancellous allograft bone sponge

Gerard Girasole, MD,1 Gerard Muro, MD,1 Abraham Mintz,1 Jason Chertoff, MD, MPH2

1Orthopaedic and Sports Medical Center, Trumbull, CT 2Department of Internal Medicine, University of Florida College of Medicine, Gainesville, FL

Abstract 

Background

Transforaminal lumbar interbody fusion (TLIF) with grafting and implant options like iliac crest bone graft (ICBG), recombinant bone morphogenetic protein (rhBMP), and polyetheretherketone (PEEK) cages have been reported to achieve extremely high fusion rates. Unfortunately, these options have also been frequently cited in the literature as causing postoperative morbidity and complications at a high cost. Knowing this, we sought to investigate TLIF using an acid-etched, roughened titanium cage that upregulates osteogenesis to see if similar fusion rates to those cited for ICBG, rhBMP, and PEEK cages could be safely achieved with minimal morbidity and complications.

Materials and methods

A radiographic fusion study of 82 patients who underwent TLIF using an acid-etched, roughened titanium cage with demineralized cancellous bone graft was conducted. Fusion was assessed and graded by an independent radiologist using computed tomography scan with sagittal and coronal reconstructions.

Results

Fusion rates at 6 months were 41 of 44 (93.2%) and at 12 months were 37 of 38 (97.4%). There were no radiographic device-related complications.

Conclusions

TLIF with an acid-etched, roughened titanium cage filled with a decalcified bone graft achieved similar fusion rates to historical controls using ICBG, rhBMP, and PEEK.

keywords: 
TLIF, Lumbar, Fusion, Graft, Recombinant human bone morphogenetic protein (rhBMP), Iliac crest bone graft (ICBG), PEEK cage
Volume 7
doi: 
10.1016/j.ijsp.2013.08.001