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Decellularized Apple-Derived Scaffolds for Bone Tissue Engineering In Vitro and In Vivo
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Bone grafting options in children.

Randal R Betz1, William F Lavelle, Amer F Samdani

  • 1Shriners Hospitals for Children, Philadelphia, PA 19140, USA. rbetz@shrinenet.org

Spine
|July 15, 2010
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Summary

Autogenous iliac crest bone grafting for adolescent idiopathic scoliosis (AIS) has complications. Alternative bone graft options, including no graft, show similar fusion rates, offering new possibilities for pediatric spinal fusion.

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Area of Science:

  • Orthopedics
  • Spinal Surgery
  • Pediatric Spine Deformity

Background:

  • Autogenous iliac crest bone graft is the standard for adolescent idiopathic scoliosis (AIS) posterior spinal fusion.
  • Donor site pain and other complications drive exploration of alternative bone grafting materials.
  • Investigated options include allografts, demineralized bone matrix, and bone morphogenetic proteins.

Purpose of the Study:

  • To review current literature and recent trends in pediatric bone grafting techniques.
  • To evaluate the efficacy of various bone grafting alternatives for spinal fusion in children.

Main Methods:

  • Retrospective review of existing medical literature.
  • Analysis of case examples to supplement literature findings.

Main Results:

  • Autogenous iliac crest bone harvesting can lead to persistent pain in up to 31% of patients at 2 years.
  • Allograft supplementation, demineralized bone matrix, and bone morphogenetic proteins show promise in achieving successful spinal fusion.
  • Posterior instrumented spinal fusion without bone graft augmentation also demonstrated successful fusion rates at 2-year follow-up.

Conclusions:

  • While autogenous iliac crest bone graft is the benchmark, alternative bone grafting materials offer comparable fusion rates.
  • The option of using no bone graft at all can yield similar fusion success in AIS patients.
  • These findings suggest a shift in bone grafting strategies for pediatric spinal fusion.