Efficacy of Beta Tricalcium Phosphate and MacroPore Sheet in Anterior Iliac Crest Reconstruction

Beta-tricalcium phosphate (B-TCP: Vitoss, Orthovita, Malverne, PA) is a newly developed non-weight bearing bone void filler. Blocks of B-TCP are osteoconductive. When combined with autogenous bone marrow aspirate, its substantial wicking capabilities, trap osteoblasts and nutrients, making it additionally osteoinductive and osteogenic.Ten patients underwent single level anterior cervical corpectomy and fusion procedures (i.e. C5-C7) with dynamic ABC plates (Aesculap, Tuttlingen, Germany). Iliac crest autografts, averaging 1.2 cm in depth x 1.4 cm in width x 2.8 cm in length, were harvested, and defects were filled with blocks of B-TCP and MacroPore Sheet (San Diego, CA). 2D-CT scans at 3 and 6 months postoperatively documented progressive fusion characterized by increasing ossification and coalescence of B-TCP particles within the defect; Grade I (50%), Grade II (70%), and Grade III (100%). Outcomes were assessed utilizing a Visual Analog Pain Scale (1-10) and the SF-36 Bodily Pain Scale recorded 3 and 6 months postoperatively.Postoperative 2D-CT studies of iliac crest reconstructions revealed Grade II (70%) partial fusion within 3 months, and Grade III (100%) complete fusion 6 months following surgery. One patient who developed a hematoma at the operative site demonstrated moderate myositis ossificans on the 2D-CT examination. On the Visual Analog Pain Scale patients demonstrated an average score of 5.2 at three months and 2.0 six months postoperatively. Bodily Pain Scores on the SF-36 showed average preoperative scores of 20, which improved to 35 at three months and 52 at six months postoperatively (higher numbers reflected better outcomes). Patients were followed a minimum of 6 months and average of 12 months postoperatively.B-TCP proved effective as a bone void filler in iliac crest donor site reconstruction and may supplement autograft and supplant allograft for comparable types of fusions.