Allograft versus autograft in instrumented posterolateral lumbar spinal fusion: a randomized control trial

To evaluate the clinical outcome respective of the type of bone graft used, 69 patients undergoing instrumented lumbar spinal fusion were randomized to receive either their own bone (harvested from the iliac crest) or allograft bone (fresh-frozen femoral head from donors undergoing total hip joint arthroplasty). Self-completed questionnaires were administered before surgery and at intervals thereafter.

To compare the clinical outcome of lumbar spinal fusion carried out using either allograft or autograft bone.

Previous studies have suggested that allograft bone is effective in cervical and thoracic fusion operations but that it is less effective in lumbar spinal fusions. Most of these studies used a radiographic means of determining fusion. However, no reliable radiologic assessment method has yet been agreed upon. It has also been shown that radiographic appearance does not correlate with clinical outcome.

A total of 69 patients undergoing instrumented posterolateral lumbar spinal fusion surgery were randomized to receive either allograft bone from the North East of Scotland Blood Transfusion Service or autologous bone from the iliac crest. The patients were then followed up at 1-year intervals over 6 years regarding clinical outcome.

Patients receiving allograft bone had outcome scores similar to those who had received their own bone, except that in the autograft group there was a significant incidence of donor site pain that was persistent in about one sixth of patients.

Allograft bone, in the form of fresh-frozen human femoral head, gives clinical results at least as good as autograft bone in instrumented posterolateral lumbar spinal fusion and completely avoids any donor site complications.