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The development of osteochondral tissue engineering is an important issue for the treatment of traumatic injury or aging associated joint disease. However, the different compositions and mechanical properties of cartilage and subchondral bone show the complexity of this tissue interface, making it challenging for the design and fabrication of osteochondral graft substitute. In this study, a bilayer scaffold is developed to promote the regeneration of osteochondral tissue within a single integrated construct. It has the capacity to serve as a gene delivery platform to promote transfection of human mesenchymal stem cells (hMSCs) and the functional osteochondral tissues formation. For the subchondral bone layer, the bone matrix with organic (type I collagen, Col) and inorganic (hydroxyapatite, Hap) composite scaffold has been developed through mineralization of hydroxyapatite nanocrystals oriented growth on collagen fibrils. We also prepare multi-shell nanoparticles in different layers with a calcium phosphate core and DNA/calcium phosphate shells conjugated with polyethyleneimine to act as non-viral vectors for delivery of plasmid DNA encoding BMP2 and TGF-β3, respectively. Microbial transglutaminase is used as a cross-linking agent to crosslink the bilayer scaffold. The ability of this scaffold to act as a gene-activated matrix is demonstrated with successful transfection efficiency. The results show that the sustained release of plasmids from gene-activated matrix can promote prolonged transgene expression and stimulate hMSCs differentiation into osteogenic and chondrogenic lineages by spatial and temporal control within the bilayer composite scaffold. This improved delivery method may enhance the functionalized composite graft to accelerate healing process for osteochondral tissue regeneration. Statement of Significance In this study, a gene-activated matrix (GAM) to promote the growth of both cartilage and subchondral bone within a single integrated construct is developed. It has the capacity to promote transfection of human mesenchymal stem cells (hMSCs) and the functional osteochondral tissues formation. The results show that the sustained release of plasmids including TGF-beta and BMP-2 from GAM could promote prolonged transgene expression and stimulate hMSCs differentiation into the osteogenic and chondrogenic lineages by spatial control manner. This improved delivery method should enhance the functionalized composite graft to accelerate healing process in vitro and in vivo for osteochondral tissue regeneration. [ABSTRACT FROM AUTHOR]

Abstract: Background: Concomitant ipsilateral femoral shaft and neck fractures present a challenge to the orthopaedic surgeon, and no consensus has yet emerged on the optimal treatment method. We report the results of a retrospective study of 43 patients with these complex fractures who were treated at a single Level 1 trauma centre. Patients and methods: The study participants consisted of 28 males and 15 females with a mean age of 43 years. The mean follow-up period was 48 months. Four different treatment methods were used: (1) antegrade reamed intramedullary nailing of the shaft with cancellous screw fixation of the neck, (2) dynamic hip screw (DHS) fixation of the neck and low-contact dynamic compression plate (LCDCP) fixation of the shaft, (3) cancellous screw fixation of the neck and LCDCP fixation of the shaft, and (4) reconstruction nailing of both shaft and neck. Results: No statistically significant differences in amount of blood loss, duration of surgery, total complication rate, nor clinical results were found among the four treatment methods. For femoral neck fracture, however, the complication rate of cannulated screw with antegrade intramedullary nailing fixation was 11 times that of DHS with LCDCP fixation. Conclusions: Antegrade nail with screw fixation is not a recommended treatment method in patients with ipsilateral femoral shaft and neck fractures. [Copyright &y& Elsevier]

Abstract: It has been shown that ultrasound (US) stimulation accelerates fracture healing in the animal models and in clinical studies. However, the precise molecular events generated by US in chondrocytes have not been clarified well. Here we found that US stimulation transiently increased the surface expression of α2, α5, β1 or β3 but not α3 or α4 integrins in human chondrocytes, as shown by flow cytometric analysis. US stimulation increased prostaglandin E2 formation as well as the protein and mRNA levels of cyclooxygenase-2 (COX-2). At the mechanistic level, anti-integrin β1 and β3 antibodies or β1 and β3 integrin small interference RNA attenuated the US-induced COX-2 expression. Integrin-linked kinase (ILK) inhibitor (KP-392), Akt inhibitor, NF-κB inhibitor (PDTC) or IκB protease inhibitor (TPCK) also inhibited the potentiating action of US. US stimulation promotes kinase activity of ILK, phosphorylation of Akt. In addition, US stimulation also induces IKKα/β phosphorylation, IκBα phosphorylation, IκBα degradation, p65 phosphorylation at Ser276, p65 and p50 translocation from the cytosol to the nucleus, and κB-luciferase activity. The binding of p65 to the NF-κB element, as well as the recruitment of p300 and the enhancement of p50 acetylation on the COX-2 promoter was enhanced by US. Taken together, our results provide evidence that US stimulation increases COX-2 expression in chondrocytes via the integrin/ILK/Akt/NF-κB and p300 signaling pathway. [Copyright &y& Elsevier]

Abstract: A retrospective study was performed to evaluate the use of an AO reconstruction plate in open reduction and internal fixation for non-union of the mid-shaft clavicle, examining the relationship between the position of the scapula and final functional results and whether perioperative variables such as clavicular reconstruction ratio and period of non-union influence the position of the scapula. From January 1998 to January 2005, data on 21 people with symptomatic non-union of the mid-shaft clavicle were collected; 17 non-unions were atrophic and 4 were hypertrophic. Initially, treatment was conservative with a figure-of-eight bandage in 19 cases, and cerclage wire fixation in 2 cases. The follow-up period was 65.7 (24–108) months. Outcome analyses included standard clinical follow-up, plain radiography, the Constant–Murley scoring and subjective assessment. All non-unions united well in 13.6 (11–27) weeks. All patients were satisfied with their surgical results. Greater age and longer period of non-union resulted in a larger amount of scapular malposition, which related to poor functional results. [Copyright &y& Elsevier]

Abstract: Background: Use of functional knee braces has been suggested to provide protection and to improve kinetic performance of the knee in anterior cruciate ligament-injured patients. However, the efficacy of knee bracing in achieving these goals is still controversial. The purpose of this study was to examine the immediate effects of functional bracing on the three-dimensional kinetics of the knee in individuals with anterior cruciate ligament injuries during level walking. Methods: Fifteen anterior cruciate ligament-deficient and 15 anterior cruciate ligament-reconstructed subjects were each fitted with a DonJoy Goldpoint brace and walked at a self-selected pace, first without and then with the brace. Kinematic and kinetic data were measured and three-dimensional joint moments and angular impulses at the knee were calculated and compared between bracing conditions and between limbs. Findings: Functional knee bracing did not significantly affect the kinetics of the unaffected knees for either group. Bracing significantly increased the peak abductor moments in anterior cruciate ligament-deficient knees and reduced the bilateral kinetic asymmetry in the coronal plane. For the anterior cruciate ligament-reconstructed group, bracing increased peak moments and impulses of the abductors and extensors. It also reduced bilateral kinetic asymmetry in the sagittal and coronal planes. Interpretation: Effects of the knee brace were apparent in the coronal plane for both anterior cruciate ligament-deficient and anterior cruciate ligament-reconstructed patients, and in the sagittal plane for anterior cruciate ligament-reconstructed patients. Functional bracing can be recommended for anterior cruciate ligament-reconstructed patients to assist in achieving better bilateral kinetic symmetry during gait. For anterior cruciate ligament-deficient patients, apart from bracing, additional emphasis on the rehabilitative training for better kinetic knee performance in the sagittal plane is needed. [Copyright &y& Elsevier]

Surgical interventions for congenital scoliosis are challenging for spine surgeons. The coordination of 3-dimensional (3D), real-time, image-guided navigation with an ultrasonic bone cutter allows surgeons to localize the affected area of the spine accurately and remove the lesion without damaging soft tissue structures. The goal of this technical paper is to report a previously undescribed method of hemivertebrectomy that combines 3D, real-time, image-guided navigation and an ultrasonic bone cutter. We highlight the feasibility and safety of this method in spinal surgery. Three patients with congenital scoliosis were treated with this technique. We present three illustrative cases comprising hemivertebrectomies for congenital scoliosis. Intraoperative photos demonstrating the technique are also provided. All surgeries were completed without complications. The hemivertebrae were completely removed, and marked correction of congenital scoliosis was noted. We believe that the combination of 3D, real-time image navigation and an ultrasonic bone cutter improves hemivertebrectomy by increasing accuracy and avoiding dura laceration, major organ damage, or potential vessel damage. [ABSTRACT FROM AUTHOR]

Soft tissue artefacts (STA) are a major error source in skin marker-based measurement of human movement, and are difficult to eliminate non-invasively. The current study quantified in vivo the STA of skin markers on the thigh and shank during cycling, and studied the effects of knee angles and pedal resistance by using integrated 3D fluoroscopy and stereophotogrammetry. Fifteen young healthy adults performed stationary cycling with and without pedal resistance, while the marker data were measured using a motion capture system, and the motions of the femur and tibia/fibula were recorded using a bi-plane fluoroscopy-to-CT registration method. The STAs with respect to crank and knee angles over the pedaling cycle, as well as the within-cycle variations, were obtained and compared between resistance conditions. The thigh markers showed greater STA than the shank ones, the latter varying linearly with adjacent joint angles, the former non-linearly with greater within-cycle variability. Both STA magnitudes and within-cycle variability were significantly affected by pedal resistance ( p < 0.05). The STAs appeared to be composed of one component providing the stable and consistent STA patterns and another causing their variations. Mid-segment markers experienced smaller STA ranges than those closer to a joint, but tended to have greater variations primarily associated with pedal resistance and muscle contractions. The current data will be helpful for a better choice of marker positions for data collection, and for developing methods to compensate for both stable and variation components of the STA. [ABSTRACT FROM AUTHOR]

Functional performance of total knee replacement (TKR) is often assessed using skin marker-based stereophotogrammetry, which can be affected by soft tissue artifacts (STA). The current study aimed to compare the STA and their effects on the kinematics of the knee between twelve patients with TKR and twelve healthy controls during sit-to-stand, and to assess the effects of STA on the statistical between-group comparisons. Each subject performed the sit-to-stand task while motions of the skin markers and the knees were measured by a motion capture system integrated with a three-dimensional fluoroscopy technique. The bone motions measured by the three-dimensional fluoroscopy were taken as the gold standard, with respect to which the STA of the markers were obtained. The STA were found to affect the calculated segmental poses and knee kinematics between the groups differently. The STA resulted in artefactual posterior displacements of the knee joint center, with magnitudes significantly greater in TKR than controls (p<0.01). The STA-induced knee external rotations in TKR were smaller than those in controls with mean differences of 2.3-3.0°. These between-group differences in the STA effects on knee kinematics in turn concealed the true between-group differences in the anterior-posterior translation and internal/external rotation of knee while leading to false significant between-group differences in the abduction/adduction and proximal-distal translation. [ABSTRACT FROM AUTHOR]

Background context Absence or inadequate filling of cement in the fractured vertebrae can cause unsatisfactory results in a vertebroplasty. Repeated needle insertion can reduce the incidence of recollapse at the cemented vertebrae. However, when inserting the second needle in the usual method, it takes the same time and radiation exposure as the first needle. Purpose To report a Kirschner wire-guided technique for inserting a second needle into inadequately filled vertebrae in vertebroplasty that can make the procedure simple, effective, and, most importantly, reduce the radiation exposure. Study design Description of a modified surgical technique with retrospective data analysis. Patient sample From January 2012 to December 2012, 87 percutaneous vertebroplasties were performed in our department to treat painful osteoporotic compression fractures. Seven adult patients (five women, two men; mean age: 75.7 years) had inadequate cement filling in the treated vertebrae that required the insertion of a second needle. Outcome measures Back pain was measured using the visual analog scale (VAS). The post-vertebroplasty anterior vertebral height and local kyphotic angle were used as the radiologic parameters. Intraoperative procedure time and fluoroscopy shots and postoperative complication were also evaluated. Methods The stylus of the first needle was inserted into the trocar to push the cement out of the trocar. The stylus was removed, a small diameter K-wire was inserted into the trocar, and the trocar was then removed. A second (new) trocar was inserted into the vertebral body following the track of the K-wire. When the new trocar reached the posterior 1/4 of the vertebral body, the K-wire was removed, the stylus was inserted, and the new needle was advanced to the anterior third of the vertebra. Cement was then injected into the new area until the filling was adequate. Results The immediate post-vertebroplasty anterior vertebral height was 23.31±1.95 mm, changed to 22.20±3.72 mm at final follow-up. The VAS decreased from a mean of 8.4 before vertebroplasty to 1.6 at the final follow-up. The follow-up duration ranged from 6 to 15 months (mean 12.6 months). There was no case of recollapse of the cemented vertebrae and no procedure-related complications. The procedure time of historical controls was 153.5 seconds, which reduced to 47.9 seconds by using this technique. The fluoroscopy shots of historical controls were 9.7 shots, which reduced to 2 shots by using this technique. Conclusions This report suggests that Kirschner wire-guided technique for inserting a second needle during vertebroplasty could make the procedure simple, effective, and, most importantly, reduce the procedure time and radiation exposure. [ABSTRACT FROM AUTHOR]

Osteochondral lesions in weight-bearing joints often fail to heal due to their poor intrinsic repair capacity and may lead to severe complications such as osteoarthritis. This study investigated the chondrogenesis, osteogenesis, and regenerative potential of an injectable, thermoresponsive chitosan-graft-poly(N-isopropylacrylamide) (CS-g–PNIPAAm, or CSPN) hydrogel combined with infrapatellar fat pad-derived mesenchymal stem cell (IFPSC) and platelet-rich plasma (PRP) with regard to osteochondral regeneration. CSPN hydrogels were prepared and characterized using several procedures. Optimal CSPN hydrogel (CSPN hydrogel with 67% of PNIPAAm, or CSPN05) was examined following a biochemical assay and animal implantation. PRP incorporated CSPN05 hydrogel, CSPN05-PRP, was fabricated. We found that rabbit IFPSCs (rIFPSCs) cultured in the CSPN05-PRP hydrogel (rIFPSC–CSPN05–PRP) enhanced the expression of chondrogenic and osteogenic genes after 1, 3, 5, and 7 days of culture and significantly increased sulfated glycosaminoglycan content, alkaline phosphatase activity, and mineralization after 5 and 7 days of culture compared with PN and CSPN05. In addition, PRP induced the expression of specific signaling molecules for chondrogenesis and osteogenesis in its signaling pathway. A preliminary in vivo study showed that rIFPSC-CSPN05–PRP could effectively regenerate the osteochondral defect at 4 weeks. Thus, the combination of IFPSC, the CSPN hydrogel, and PRP can synergistically enhance chondrogenic and osteogenic gene expression, cartilage- and bone-specific extracellular matrix production, hyaline cartilage regeneration, and mineralized osseous tissue formation. CSPN scaffolds with PRP show potential as biomaterial by providing mechanical support for cell growth and inducing stem cells to differentiate into osteochondral lineages for application in regenerative medicine. [Display omitted] [ABSTRACT FROM AUTHOR]

Abstract: Background: Diabetes is an independent risk factor of osteoarthritis (OA). Angiogenesis is essential for the progression of OA. Here, we investigated the intracellular signaling pathways involved in high glucose (HG)-induced vascular endothelial growth factor (VEGF) expression in human synovial fibroblast cells. Methods: HG-mediated VEGF expression was assessed with qPCR and ELISA. The mechanisms of action of HG in different signaling pathways were studied using Western blotting. Knockdown of proteins was achieved by transfection with siRNA. Chromatin immunoprecipitation assays were used to study in vivo binding of c-Jun to the VEGF promoter. Results: Stimulation of OA synovial fibroblasts (OASF) with HG induced concentration- and time-dependent increases in VEGF expression. Treatment of OASF with HG increased reactive oxygen species (ROS) generation. Pretreatment with NADPH oxidase inhibitor (APO or DPI), ROS scavenger (NAC), PI3K inhibitor (Ly294002 or wortmannin), Akt inhibitor, or AP-1 inhibitor (curcumin or tanshinone IIA) blocked the HG-induced VEGF production. HG also increased PI3K and Akt activation. Treatment of OASF with HG increased the accumulation of phosphorylated c-Jun in the nucleus, AP-1-luciferase activity, and c-Jun binding to the AP-1 element on the VEGF promoter. Conclusions: Our results suggest that the HG increases VEGF expression in human synovial fibroblasts via the ROS, PI3K, Akt, c-Jun and AP-1 signaling pathway. General significance: We link high glucose on VEGF expression in osteoarthritis. [Copyright &y& Elsevier]

Abstract: Purpose: Patients with un-relieved pain after vertebroplasty due to re-collapse of the cemented vertebrae have been reported. Here we report a technique of vertebroplasty that can reduce the incidence of re-collapse at the cemented vertebrae. Materials and methods: Between March 2002 and September 2008, 134 patients with 205 painful vertebral compression fractures underwent vertebroplasty in our institutes. The indication of using this technique was unfilled area more than 25% of the vertebral body height in lateral radiograph. The vertebroplasty procedure was performed according to the technique described by Jensen. If the unfilled area were more than 25% of the vertebral body height in lateral radiograph, another needle would be inserted aiming at the unfilled area. As outcome measurement, a visual analog scale with 10 divisions and plain radiographs (to measure the anterior vertebral body height of cemented vertebrae) were used. Results: Thirteen vertebrae were treated with this technique. The mean age was 74.4years. The immediate post-vertebroplasty anterior vertebral height was 24.92±3.59mm, changed to 23.52±3.54mm at final follow-up. The visual analog scale decreased from a mean of 8.7 before vertebroplasty to 2.3 at final follow-up. The follow-up duration ranged from 15 to 38 months (mean 18.5 months). There was no case of re-collapse of the cemented vertebrae, and no procedure-related complications. Conclusion: In the treatment of vertebral compression fractures by percutaneous vertebroplasty, repeat needle insertion to the unfilled area may be helpful to decrease the incidence of re-collapse of cemented vertebrae if the unfilled area is more than 25% of the vertebral body height in lateral radiograph. [Copyright &y& Elsevier]

Abstract: Osteosarcoma is characterized by a high malignant and metastatic potential. Cyclooxygenase (COX)-2, the inducible isoform of prostaglandin synthase, has been implicated in tumor metastasis. Nephroblastoma overexpressed gene (NOV), also called CCN3, was regulated proliferation and differentiation of cancer cells. However, the effect of NOV on migration activity and COX-2 expression in human osteosarcoma cells is mostly unknown. Here we found that NOV increased the migration and expression of COX-2 in human osteosarcoma cells. αvβ5 monoclonal antibody (mAb), integrin-linked kinase (ILK) and Akt inhibitor reduced the NOV-enhanced the migration and COX-2 up-regulation of osteosarcoma cells. NOV stimulation increased the ILK kinase activity and phosphorylation of Akt. In addition, c-Jun siRNA also antagonized the NOV-mediated migration and COX-2 expression. Moreover, NOV enhanced the AP-1 binding activity and promoter activity. Taken together, these results suggest that the NOV acts through αvβ5 integrin to activate ILK and Akt, which in turn activates c-Jun and AP-1, resulting in the activations of COX-2 and contributing the migration of human osteosarcoma cells. [Copyright &y& Elsevier]

Abstract: CCL5 (previously called RANTES) is in the CC-chemokine family and plays a crucial role in the migration and metastasis of human cancer cells. Besides, integrins are the major adhesive molecules in mammalian cells. Here we found CCL5 increased the migration and cell surface expression of αvβ3 integrin in human lung cancer cells (A549 cells). CCL5 stimulation increased phosphorylation of the p85α subunit of phosphatidylinositol 3-kinase (PI3K) and serine 473 of Akt. Also, we found that PI3K inhibitor (Ly294002) or Akt inhibitor suppressed CCL5-induced migration activities and integrin expression of A549 cells. Transfection of cells with p85 or Akt mutant also reduced CCL5-mediated cancer migration. In addition, treatment of A549 cells with CCL5 induced IκB kinase α/β (IKK α/β) phosphorylation, IκB phosphorylation, p65 Ser536 phosphorylation, and κB-luciferase activity. Furthermore, the CCL5-mediated increases in p65 Ser536 phosphorylation were inhibited by Ly294002 and Akt inhibitor. Taken together, our results suggest that CCL5 acts through PI3K/Akt, which in turn activates IKKα/β and NF-κB, resulting in the activation of αvβ3 integrin and contributing to the migration of human lung cancer cells. [Copyright &y& Elsevier]

Abstract: Measurement of the changes of the three-dimensional (3D) motion and surface kinematics of the knee under different external loading conditions is essential for the understanding and evaluation of the function of the joint, as well as for relevant clinical applications. Knee extension exercise (KEE) has been applied extensively in the rehabilitation programs of patients with various knee disorders. This study measured the 3D knee kinematics of eight normal subjects during active knee extension for unloaded and loaded conditions using a voxel-based method for the registration of fluoroscopic images with CT bone data. The knee kinematics during unloaded conditions were found to be similar to previous findings. A mass of 5kg at the ankle did not affect the joint angles but significantly altered the lateral contact positions during knee extension, especially at knee flexion angles higher than 75°, and also reduced the asymmetry of the surface kinematics between the medial and lateral condyles. The results of the current study may be useful for knee replacement design and for developing guidelines for the use of KEEs for the rehabilitation of patients with knee disorders. [Copyright &y& Elsevier]

Abstract: Thrombin is a key factor in the stimulation of fibrin deposition, angiogenesis and proinflammatory processes. Abnormalities in these processes are primary features of rheumatoid arthritis (RA) in synovial tissues. We investigated the signaling pathway involved in IL-6 production caused by thrombin in synovial fibroblasts. Thrombin caused concentration- and time-dependent increases in IL-6 production. By using pharmacological inhibitors or activators or genetic inhibition by the protease activated receptor (PAR), siRNA revealed that the PAR1 receptor but not other PAR receptors is involved in thrombin-mediated up-regulation of IL-6. Thrombin-mediated IL-6 production was attenuated by thrombin inhibitor (PPACK), phospholipase C inhibitor (U73122), protein kinase Cα inhibitor (Ro320432), Src inhibitor (PP2), NF-κB inhibitor (PDTC), IκB protease inhibitor (TPCK), or NF-κB inhibitor peptide. Stimulation of synovial fibroblasts with thrombin activated IκB kinase α/β (IKK α/β), IκBα phosphorylation, IκBα degradation, p65 phosphorylation at Ser276, p65 and p50 translocation from the cytosol to the nucleus, and κB-luciferase activity. Thrombin-mediated an increase of IKK α/β activity, κB-luciferase activity and p65 and p50 binding to the NF-κB element was inhibited by PPACK, U73122, Ro320432 and PP2. The binding of p65 and p50 to the NF-κB elements, as well as the recruitment of p300 and the enhancement of p50 acetylation on the IL-6 promoter was enhanced by thrombin. Our results suggest that thrombin increased IL-6 production in synovial fibroblasts via the PAR1 receptor/PI-PLC/PKCα/c-Src/NF-κB and p300 signaling pathway. [Copyright &y& Elsevier]

Female athletes are two to eight times more likely to suffer a knee or ankle ligament injury than male athletes, and sex hormones have been considered to play an important role in the injury. Because ligaments are always under mechanical loading during sports, mechanical force is also a critical factor in ligament injuries. In this study, the effects of estrogen and mechanical loading on the gene expression of three major components of ligament—collagen type I, type III, and biglycan—in primary cultured porcine anterior cruciate ligament (ACL) fibroblasts were investigated individually and collectively using reverse transcript-polymerase chain reaction (RT-PCR). The results revealed that cyclic tensile loading alone increased the messenger RNA expression of collagen I but did not affect that of collagen III and biglycan, and estrogen alone increased the gene expression of collagen I and III but not of biglycan. However, combined administration of estrogen and cyclic loading inhibited the mRNA expression of all the three genes. These results suggested that the inhibition of the gene expression of major extracellular matrix component molecules caused by the combined effects of estrogen and mechanical loading, unique to females, might be responsible for the increased incidence of ligaments injury in female athletes. [Copyright &y& Elsevier]

Abstract: Background: This was a retrospective study of clinical results for single-segment posterolateral lumbar fusion using local autograft bone with bone expander. Methods: Sixty-six patients underwent single-segment decompression with instrumented posterolateral fusion. Locally harvested morselized bone from the decompressive site mixed with 2 mL calcium sulfate (OSTEOSET, Wright Medical Technology, Arlington, TN, USA) was used for the fusion at the posterolateral aspect of the lumbar spine. The minimum follow-up period was 15 months. The status of the fusion was evaluated by plain film, flexion-extension view, and fine-cut computed tomography (CT) with coronal reconstruction. Radiographic fusion criteria included less than 5° of angular motion, less than 2 mm of translation, and evidence of bridging bone in the posterolateral lumbar area on the CT scan. The clinical outcome was recorded using VAS score and the ODI. The results were then compared with the result of the other group who had received the same procedure except that a pure autogenous bone graft harvested from the PSIS was used. Results: In the group using local bone and OSTEOSET, the fusion rate was 92.3% by the strict criteria. The VAS scores for leg pain and back pain were decreased in the 2 groups, but there was no significant difference between them. The improvement in the ODI was also similar between the 2 groups. Intraoperative blood loss and the time needed for the operation were significantly decreased in the group using local bone and OSTEOSET as the bone graft. In the group using autogenous bone graft, donor site morbidity was still encountered. Conclusions: Using local laminectomy bone with calcium sulfate as bone graft is a practical option in posterolateral lumbar fusion with the advantages of less operative time, less blood loss, and avoidance of donor site morbidity. [Copyright &y& Elsevier]