Gene-Activated Octacalcium Phosphate (OCP/VEGF) Versus Autologous Bone Graft for Single-Level TLIF in Degenerative Lumbar Stenosis

Background: Autologous bone graft is widely used for lumbar interbody fusion but may increase operative time and donor-site morbidity. Gene-activated grafts combining an osteoconductive scaffold with pro-angiogenic signaling may provide comparable fusion without graft harvesting. The aim of this paper is to compare radiographic fusion and health-related quality of life after single-level transforaminal lumbar interbody fusion (TLIF) using a gene-activated octacalcium phosphate graft containing plasmid DNA encoding vascular endothelial growth factor (OCP/VEGF) versus an autologous bone graft.

Methods: 200 adults undergoing first-time single-level TLIF for degenerative lumbar stenosis were allocated 1:1 to OCP/VEGF (n = 100) or autograft (n = 100), prospectively. CT-based fusion assessment and SF-36 outcomes were evaluated at 6 and 12 months follow-up.

Results: At 12 months after surgery, mean fusion-zone density was 617.6 ± 180.9 HU in the OCP/VEGF group versus 599.8 ± 181.9 HU in the autograft group (mean difference 17.8 HU; p = 0.484). Complete fusion on qualitative CT grading occurred in 77% versus 73%, respectively (risk difference 4%; p = 0.583). SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) improved significantly from baseline in both groups (p < 0.001), without clinically meaningful between-group differences at follow-up. Revision surgery occurred in 3% versus 5%. Conclusions: In single-level TLIF for degenerative lumbar stenosis, OCP/VEGF produced radiographic fusion and patient-reported outcomes comparable to autograft at 12 months, supporting its use as an autograft-sparing alternative.

The full version of the article is available on the website:

https://www.mdpi.com/journal/surgeries/special_issues/F16C8671GW

Renat Madekhatovich Nurmukhametov ^1,2, Medetbek Dzhumabekovich Abakirov ^1,2, Stepan Anatolyevich Kudryakov ², Medet Kaskirbayevich Dosanov ², Dilerbek Nuriddinov ³, Batzayaa Beis Zhanchivdorj ³, Kerly Sulay Borja Cevallos ³, Ilya Yadigerovich Bozo ⁴, Alberto Luis Martinez Mateo ⁵ and Nicola Montemurro ⁶

1. Department of Neurology and Neurosurgery with a Course in Comprehensive Rehabilitation, Peoples’ Friendship University of Russia (RUDN University), 117593 Moscow, Russia
2. Neurosurgery Department, National Clinical Center No. 2, Federal State Budgetary Scientific Institution “Russian Scientific Center of Surgery Named after Academician B.V. Petrovsky”, 117593 Moscow, Russia
3. Department of Nervous Diseases and Neurosurgery Named after Professor Yu. S. Martynov, Peoples’ Friendship University of Russia (RUDN University), 117198 Moscow, Russia
4. Department of Maxillofacial and Reconstructive Plastic Surgery, National Clinical Center No. 2, Federal State Budgetary Scientific Institution “Russian Scientific Center of Surgery named after Academician B.V. Petrovsky”, 117593 Moscow,
5. Traumatology Hospital, Dario Contreras, Santo Domingo 11503, Dominican Republic
6. Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), 56100 Pisa, Italy