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Are the additional grafts necessary?

Z B Milinković1, O Krneta, S Milicković

  • 1Spinal Center, Institute for Surgical and Orthopedic Diseases "Banjica", Belgrade University of Belgrade.

Acta Chirurgica Iugoslavica
|August 5, 2010
PubMed
Summary
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This study found that using local bone graft from the spine, instead of iliac crest bone graft, is effective for achieving spinal fusion in adolescent idiopathic scoliosis surgery. This approach avoids complications associated with iliac crest bone harvesting.

Area of Science:

  • Orthopedic Surgery
  • Spinal Fusion
  • Adolescent Idiopathic Scoliosis

Background:

  • Spinal deformity surgery aims for a stable, fused spine, with solid arthrodesis being crucial for long-term success.
  • Traditionally, copious autogenous iliac graft is used, but it has limitations regarding quantity, surgical time, and donor site complications.
  • Bone substitutes offer alternatives but lack ideal osteoinductive and osteoconductive properties and pose risks like infection and high cost.

Purpose of the Study:

  • To evaluate the efficacy of using locally harvested bone graft (from laminae and spinous processes) for spinal fusion in adolescent idiopathic scoliosis.
  • To assess the outcomes of posterior spinal correction using segmental fixation without autogenous iliac crest graft or bone substitutes.

Main Methods:

  • A retrospective study of 188 patients with adolescent idiopathic scoliosis who underwent posterior correction with segmental fixation (Moss-Miami).

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  • Local bone graft was obtained from decortication of laminae and spinous processes, with facet joint destruction.
  • No autogenous iliac crest graft or bone substitutes were used; follow-up was at least 30 months.

    • Main Results:

    • Excellent results were achieved in 177 out of 188 patients, with a fused spine, no implant failure, pain, infection, or loss of correction.
    • Re-operation was required in 11 patients (5.8%) for infection (4), symptomatic implants (3), or pseudarthrosis (4).

    Conclusions:

    • Local bone graft harvested from the spine (laminae and spinous processes) is sufficient for achieving solid spinal fusion (spondylodesis) in adolescent idiopathic scoliosis.
    • This technique eliminates the need for autogenous iliac crest bone graft, thereby avoiding associated morbidity.