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Anterior Lumbar Interbody Fusion with Processed Sea Coral (Coralline Hydroxyapatite) as Part of a Circumferential Fusion

Thalgott, John S., MD*†; Klezl, Zendek, MD; Timlin, Marcus, MD*; Giuffre, James M., BA*

Clinical Case Series

Study Design. A retrospective review of 20 patients undergoing circumferential lumbar fusion with coralline hydroxyapatite blocks anteriorly and autograft with transpedicular or translaminar facet screw fixation posteriorly.

Objectives. To examine the efficacy of coralline hydroxyapatite as a bone graft substitute for anterior lumbar interbody fusion.

Summary of Background Data. Autograft is the gold standard for bone grafting in the anterior lumbar spine. Harvesting bone from the iliac crest leads to significant postoperative pain and morbidity. Femoral ring allograft is a widely used alternative to autograft but has some inherent problems. Coralline hydroxyapatite was shown to be 100% successful for anterior cervical fusion when combined with rigid plating.

Methods. A retrospective review of 20 patients with low back pain and indicated for surgical intervention. A circumferential instrumented fusion was performed with coralline hydroxyapatite blocks anteriorly and transpedicular or translaminar facet fixation and autograft posteriorly. All patients reached a minimum 3-year clinical and radiologic follow-up.

Results. Radiographic follow-up yielded a solid arthrodesis rate of 93.8% by level (30 of 32 disc spaces) and 90% by patient (18 of 20). Clinical follow-up generated a mean pain reduction of 61.8% with clinical success demonstrated in 80% (16 of 20) of all patients who reported good or excellent pain relief. Eight of 12 (66.7%) patients employed before surgery returned to work in some capacity.

Conclusions. Coralline hydroxyapatite is a practicable anterior lumbar interbody fusion alternative to autograft and allograft as part of a circumferential fusion with rigid posterior fixation. It is not recommended for stand-alone anterior lumbar interbody fusion without further study.

From the *International Spinal Development & Research Foundation, Las Vegas,

the †University of Nevada School of Medicine, Las Vegas, Nevada,

‡Military Medical Academy JP, Hradec Kralove, and the Central Military Hospital Prague, Department of Orthopaedics and Traumatology, Prague, Czech Republic.

Research support provided by Interpore Cross International, Irvine, California.

Acknowledgment date: March 14, 2001.

First revision date: July 6, 2002. Second revision date: October 22, 2001.

Acceptance date: May 20, 2002.

The device(s)/drug(s) that is/are the subject of this manuscript is/are not FDA-approved for this indication and is/are commercially available in the United States.

Corporate/Industry funds were received to support this work. Although one or more of the author(s) has/have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this manuscript, benefits will be directed solely to a research fund, foundation, educational institution, or other nonprofit organization which the author(s) has/have been associated.

Address correspondence to John S. Thalgott, MD, International Spinal Development & Research Foundation, 600 South Rancho Drive, Suite 101, Las Vegas, NV 89106, USA; E-mail:

© 2002 Lippincott Williams & Wilkins, Inc.