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Validation of Impaction Grafting for Single-Level Transforaminal Lumbar Interbody Fusion-Technical Pearls and MicroCT
Paul Justin Tortolani1, Sarah L Lucas2, Gnel Pivazyan3,4
1Department of Orthopedic Surgery, University of Maryland St. Joseph Medical Center, Towson, MD.
Spine
|February 2, 2023
Summary
Impaction grafting (IG) significantly enhances transforaminal lumbar interbody fusion (TLIF) by increasing bone volume and contact area. This technique shows promise for improving spinal fusion rates.
Area of Science:
- Orthopedic Surgery
- Spinal Fusion Techniques
- Biomaterials Science
Background:
- Transforaminal lumbar interbody fusion (TLIF) is a standard surgical technique for lumbar spine pathology.
- The impact of impaction grafting (IG) on the microstructural properties of TLIF has not been previously investigated.
Purpose of the Study:
- To quantify the increase in bone volume and endplate contact area with IG augmentation in TLIF.
- To determine the amount of bone graft material required for maximal impaction during TLIF.
Main Methods:
- A cadaveric study using 9 functional spinal units from lumbosacral spine specimens.
- TLIF procedures were performed, followed by microcomputed tomography (CT) scans to assess bone volume and bone surface contact area (BSCA).
- IG augmentation was then applied, and micro-CT scans were repeated to evaluate changes.
Main Results:
- IG augmentation of TLIF resulted in a 346% increase in final bone volume and a 152% increase in BSCA.
- The average collected autogenous bone (8.21 cm³) was sufficient for grafting requirements.
- Significant improvements in bone volume and BSCA were observed compared to non-impacted TLIF.
Conclusions:
- Impaction grafting augmentation significantly enhances bone volume and bone surface contact area in TLIF procedures.
- Increased BSCA and bone volume suggest a potential for improved spinal fusion rates.
- Further clinical studies are necessary to validate these in vitro findings.
