Case series 1

In a two-year clinical case series by Jenis there was no difference in fusion rates between Actifuse plus BMA (combination chosen for handling purposes) and those historically gained by this author using iliac crest autograft alone.1

  • 36 patients have completed 12 month follow up and 20 patients have completed 24 month follow up
  • Fusion rate was 35% at 6 months, 77.7% at 12 months and 75.9% at 24 months based on fine cut computed tomography (CT) assessment
  • Fusion rates are comparable to the centre’s own historical fusion rates of 73%
  • Back and leg pain improved by 65% and 80%, respectively
  • No patient required revision surgery
  • There were no significant complications

Case Report

As a result of a previous injury that was treated conservatively the patient had continuing back pain. Preoperative magnetic resonance imaging (MRI) confirmed severe spinal stenosis ranging from L3 to L5. The patient underwent posterior L3 to L5 laminectomy with instrumented PLF.

6-Month coronal CT

At 6 months, early fusion and healing was noted. At this time point, the granularity of Actifuse can be seen clearly on the CT.

6 month coronal

12-Month coronal CT

At 12 months the patient has resolved leg pain, and has minimal lower back pain. The granular appearance is reducing as Actifuse is resorbed and replaced by bone. Solid bilateral facet fusion was seen throughout.

12th month coronal

24-Month coronal CT

At 24 months, CT imaging confirms the graft incorporation especially into the posterior aspects of the transverse processes. The bone covering the graft site is now indistinguishable from the bone in nongrafted areas. The patient continues to do well clinically.

24 month coronal CT

The findings from this study confirm that Actifuse can achieve successful posterior lumbar fusion when combined with BMA. In addition, as a result of this long term follow-up data, the author has modified his practice to use Actifuse in place of iliac crest bone graft.

 

  1. Jenis LG, Banco RJ. Clinical and radiographic evaluation of silicate-substituted calcium phosphate ceramic in posterolateral lumbar spinal fusion. One and two year results. Case series.