Posterlateral Spine Fusion


using GraftonŽ DBM Flex and Putty

Frank P. Cammisa, Jr., M.D., F.A.C.S.
Chief, Spine Services
Hospital For Special Surgery, New York, NY

Posterlateral Spine Fusion

Overview


Due to the complexity of this case, Dr. Cammisa chose to use both Grafton DBM Flex and Grafton DBM Putty. The following are Dr. Cammisa's guidelines for use.

Patient Background


The patient is a 44-year-old female who, at age 17, underwent anterior fusion surgery for a fracture of the mid-lumbar spine. She developed hyperlordosis at the lumbosacral junction, which allowed compensation and kept her sagittally well-balanced. Over the years, she developed degenerative changes resulting in spinal stenosis and retrospondylolisthesis. This surgery allowed decompression of her neural elements and stabilized her lower lumbar spine in a good position to maintain sagittal balance.

Procedure


  • Place pedicle screws in appropriate area according to manufacturer's recommendations.
  • Obtain cortical cancellous autograft bone from the iliac crest and morselize.
  • Using proper sterile techniques, add 10cc Grafton DBM Putty to morselized autograft bone and mix together until a pasty substance is formed. A ratio of bone to Grafton DBM of at least 2:1 is recommended.
  • Using proper sterile technique, remove one 10cm x 2.5cm Grafton DBM Flex and soak for two to three minutes in autologous blood, enabling the Flex to grow in thickness while becoming more flexible.
  • Cut the Grafton DBM Flex strip in half lengthwise, forming two strips.
  • Irrigate the graft site now. Properly prepare graft site by decorticating and burring both facets and transverse processes down to good bleeding cancellous bone. Remove all cartilage from facet area.
  • Clean and morselize recovered local bone from lamina and mix with the Grafton DBM Putty-autograft mixture.
  • Place one of the Grafton DBM Flex strips along the transverse processes and the other strip along the facet area. This will provide a nice foundation for the fusion, as well as osteoinductivity and osteoconductivity along the graft bed.
  • Pack the bone graft mixture onto the Flex strips and in and around the facet area.
  • Place instrument rod.
  • Repeat same procedure for other side.