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A prospective long-term follow-up study of bioactive glass (BAG)-S53P4 and autogenous bone (AB) used as bone graft substitutes for posterolateral spondylodesis in treatment of degenerative spondylolisthesis during 1996 to 1998 was conducted. The surgical procedure was a standardized instrumented posterolateral fusion that used USS/VAS. BAG was implanted on the left side of the fusion bed and AB on the right side. The operative outcome was evaluated on x-rays and computed tomography scans, and a clinical examination was also performed. Seventeen patients (12 women, 5 men) participated in the 11-year follow-up. The mean Oswestry Disability Index score at the follow-up was 21 (range 0 to 52), compared with 49 (range 32 to 64) at the preoperative time. A solid bony fusion was seen on computed tomography scans on the AB side in all patients and on the BAG side in 12 patients. The fusion rate of all fusion sites (n=41) for BAG as a bone substitute was 88% at the L4/5 level and 88% at the L5/S1 level. The use of BAG as a bone graft extender can be considered as a good alternative in spinal surgery in the future.