{"id":"78a82de8-6342-4078-acb6-b53123b5b9fa","slug":"high-lumbar-noninstrumented-fusion-rates-using-lamina-autograft-and-nanossbone-marrow-aspirate","title":"High lumbar noninstrumented fusion rates using lamina autograft and Nanoss/bone marrow aspirate","authors":["Nancy E. Epstein"],"abstract":"Background: Patients with marked osteoporosis and/or obesity/morbid obesity and severe multilevel lumbar stenosis and other pathology often undergo multilevel laminectomies with non instrumented posterolateral fusions (PLF). The other pathology may include combinations of degenerative spondylolisthesis/lysis, foraminal/far lateral discs, and/or synovial cysts requiring more extensive facet resections. Presently, spine surgeons often use bone graft expanders to supplement the lamina autograft harvested in the course of laminectomy/decompressions for the PLF mass. Methods: In 59 patients, we prospectively analyzed the fusion rates following multilevel laminectomies/noninstrumented fusions using lamina autograft and the bone graft expander Nanoss (RTI Surgical Alachua, FL, and USA) with autogenous bone marrow aspirate (BMA). Patients averaged 66.1 years of age; many exhibited marked osteoporosis (48 patients) and obesity (13 of 27 morbidly obese). Magnetic resonance (MR) and computed tomography (CT) studies documented stenosis/ossified yellow ligament (OYL) and degenerative spondylolisthesis (51 patients)/lysis (2 patients), synovial cysts (32 patients), and disc herniations (10 of 21 far lateral). Patients were followed remove up for an average of 3.12 years. Results: Average 4.0 level laminectomies/1.2 level noninstrumented fusions utilized lamina autograft and Nanoss/BMA. Both X-ray/CT studies performed an average of 4.9 months postoperatively documented a 97% fusion rate (57 of 59 patients). Two patients with severe osteoporosis, morbid obesity, and smoking histories exhibited pseudarthroses; neither was sufficiently symptomatic to require secondary surgery. Conclusions: Fifty-nine patients with multilevel lumbar stenosis/OYL and other pathology underwent multilevel lumbar laminectomies/noninstrumented fusions using lamina autograft and Nanoss/BMA. Both dynamic X-ray/CT studies confirmed a 97% fusion rate an average of 4.9 months postoperatively. Nanoss/BMA contributed to a high posterolateral lumbar non instrumented fusion rate without complciations.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/78a82de8-6342-4078-acb6-b53123b5b9fa/featured/hero-1782420910453.png","publishDate":"2017-07-20T00:00:00.000Z","doi":"10.4103/sni.sni_248_17","categories":["Spine","Original Article"],"fullTextUrl":"https://surgicalneurologyint.com/api/articles/78a82de8-6342-4078-acb6-b53123b5b9fa/pdf"}