Discussion
alcoholism, PLF, nonunion, fracture, tuberculosis, pain, pseudoarthrosis, Allograft infection, disability
TUBERCULOSIS, PSEUDOARTHROSIS, OSTEOPOROSIS, OF DISEASE TRANSMISSION, MALNUTRITION, COMPLICATIONS
Despite the dramatically higher number of lumbar spinal fusion procedures over the past decade, the potential for pseudoarthrosis persists [Cellular bone allografts are an alternative to autograft given they have all three principal components of a bone graft, namely osteoconductivity, osteoinductivity, and osteogenicity. Several studies provide support for high fusion rates using CBA in keeping with the current report. Musante et al. report 90.0% fusion success in procedures using viable osteogenic cells, with no differences in reported fusion rates in patients with and without risk factors [Significant improvements in clinical outcomes evaluating patient-reported levels of disability and pain were observed. All clinical outcome measures met statistical and clinical significance criterion, further demonstrating the positive impact and meaningful improvement from lumbar spinal fusion in this population. These findings are consistent with other reports showing significant improvements in ODI and VAS disability and pain scores following surgical procedures with CBA. Tohmeh et al. report a 41.0%, 55.0% and 43.0% improvement in ODI, VAS-Back and VAS-leg pain scores postoperatively at 12 months, respectively [Of note, the small number of subjects that did not have successful fusion also showed improved clinical outcomes. If a solid fusion is not obtained, but stability to the spine is supported through the instrumentation, the patient may still achieve clinical improvements. Lack of angular and translational motion in addition to bridging bone was the per-protocol definition of fusion. For the majority of subjects with a failed fusion, bridging bone was present which likely contributed to the stability of the spine even though they failed the QMA assessment.Fusion success and clinical outcomes may be affected by patient risk factors for pseudoarthrosis, including older age, osteoporosis, alcoholism, malnutrition, and smoking [The study presented several limitations that should be noted. Varying surgical approaches (e.g., TLIF, ALIF, PLF) were included within this analysis, as opposed to a single approach. This analysis does not include a control arm for comparison, the only comparison to outcomes identified within come from the available scientific literature. Despite these limitations, the preliminary data provided within this report demonstrates that CBA is an effective bone graft alternative and adjunct for patients being treated with lumbar spinal fusion.Allograft infection can lead to disastrous complications such as nonunion of the graft-host junction and fracture of the graft requiring surgical intervention. While there has been a recent report of disease transmission through the usage of a different CBA where multiple tuberculosis cases in graft recipients were traced to a single donor lot [