The Journal of Neurosurgery Spine Edition recently published a paper entitled “Clinical outcomes and fusion rates following anterior lumbar interbody fusion with bone graft substitute i-FACTOR, an anorganic bone matrix/P-15 composite” by Ralph J. Mobbs, B.Sc., M.B.B.S., M.S., F.R.A.C.S.,1,2 Monish Maharaj, M.D.,2 and Prashanth J. Rao, M.D.1,2 1 NeuroSpineClinic, Prince of Wales Private Hospital; and 2 Faculty of Medicine, University of New South Wales, Sydney, Australia.

Results
All patients who received i-FACTOR demonstrated radiographic evidence of bony induction and early incorporation of bone graft. At a mean of 24 months of follow-up (range 15–43 months), 97.5%, 81%, and 100% of patients, respectively, who had undergone single-, double-, and triple-level surgery exhibited fusion at all treated levels. The clinical outcomes demonstrated a statistically significant (p < 0.05) difference between preoperative and postoperative Oswestry Disability Index, 12-Item Short Form Health Survey, and visual analog scores.

Conclusions
Anterior lumbar interbody fusion using i-FACTOR (ABM/P-15) synthetic bone graft substitute is a useful treatment option for degenerative pathologies of the lumbar spine. The present study demonstrates a high fusion rate and clinical improvements comparable to the published results for ALIF using autograft or BMP. At the same time the use of ABM/P-15 as a graft material avoids the complications specific to those 2 materials. Further studies comparing rate of arthrodesis, clinical outcome, and cost between ABM/P-15 and other graft alternatives are warranted.