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Effective use of novel biphasic calcium phosphate with submicron surface topography in posterolateral spine fusion
Abstract: The number of spine fusion procedures continues to increase with the aging population. Posterolateral spinal fusion (PLF) is one of the more challenging clinical indications in the spine requiring a bone graft because the aim is to form a large, consolidated bone mass through the paraspinous soft tissues with limited host bone contact. Synthetic calcium phosphate bone graft usage has increased in recent years, reducing the need to harvest large amounts of autologous bone. This class of bone graft closely resembles the composition of human cancellous bone and demonstrates a low incidence of adverse reactions and graft-related complications in the clinic. The body’s natural response to the tissue trauma associated with spinal surgery is the upregulation of macrophages of the pro-inflammatory M1 phenotype. This can lead to the formation of scar tissue and failed fusion. This biphasic calcium phosphate (BCP) bone graft with a unique submicron needle-shaped surface topography has been shown in in vitro studies of human-derived monocytes to promote attachment and spreading of anti-inflammatory M2 macrophages, leading to the formation of bone instead of scar tissue. This report on a consecutive case series assessed radiographic, functional and pain outcomes following posterolateral lumbar fusion using a novel biphasic calcium phosphate bone graft with a unique submicron topography in a potentially bone-density-challenged group of female patients.