Preliminary Documentation of the Comparable Efficacy of Vitoss Versus NanOss Bioactive As Bone Graft Expanders for Posterior Cervical Fusion

Background: Laminectomies with posterior cervical instrumented fusions often utilize bone graft expanders to supplement cervical lamina/iliac crest autograft/bone marrow aspirate (BMA). Here we compared posterior fusion rates utilizing two graft expanders; Vitoss (Orthovita, Malvern, PA, USA) vs. NanOss Bioactive (Regeneration Technologies Corporation [RTI: Alachua, FL, USA]).

Methods: Two successive prospective cohorts of patients underwent 1-3 level laminectomies with 5-9 level posterior cervical fusions to address cervical spondylotic myelopathy (CSM) and/or ossification of the posterior longitudinal ligament (OPLL). The first cohort of 72 patients received Vitoss, while the second cohort or 20 patients received NanOss. Fusions were performed utilizing the Vertex/Rod/Eyelet System (Medtronic, Memphis, TN, USA) with braided titanium cables through the base of intact spinous processes (not lateral mass screws) cephalad and caudad to laminectomy defects. Fusion was documented by an independent neuroradiologist blinded to the study design, utilizing dynamic X-rays and two dimensional computed tomography (2D-CT) studies up to 6 months postoperatively, or until fusion or pseudarthrosis was confirmed at 1 year.

Results: Vitoss and NanOss resulted in comparable times to fusion: 5.65 vs. 5.35 months. Dynamic X-ray and CT-documented pseudarthrosis developed in 2 of 72 Vitoss patients at one postoperative year (e.g. bone graft resorbed secondary to early deep wound infections), while none occurred in the 20 patients receiving NanOss.

Conclusion: In this preliminary study combining cervical laminectomy/fusions, the time to fusion (5.65 vs. 5.35 months), pseudarthrosis (2.7% vs. 0%), and infection rates (2.7% vs. 0%) were nearly comparable sequentially utilizing Vitoss (72 patients) vs. NanOss (20 patients) as bone graft expanders.