Posterior spinal fusion supplemented with only allograft bone in paralytic scoliosis. Does it work?

The authors prospectively evaluated 40 patients with paralytic scoliosis treated from 1985 to 1990 with bilateral posterior segmental instrumentation, facet fusions, local bone graft, and allograft (mostly fresh frozen) bone supplementation only.

The authors report the fusion results for these patients, and any complications referable to the use of bank bone.

Acceptable correction was obtained and maintained in the coronal and sagittal planes for all but two patients (the third patient with a pseudarthrosis had not lost correction). The definite pseudarthrosis rate was 7.5%. One patient had a deep wound infection.

The radiographs were graded as definitely solid, definitely a pseudarthrosis, or no instrumentation failure but difficult to visualize the whole fusion mass. The patients selected for fusion without autogenous harvesting were especially frail and had reduced pulmonary and nutritional reserve. Follow-up ranged from 2 + 2 years to 7 + 6 years, with an average of 3 + 9 years.

In the 40 surgical patients, there were three known pseudarthroses. In 28 patients, there was a definite fusion. In the remaining nine patients (five with flaccid disease, four with spastic disease), the quality of their bone precluded definitive determination, but there was no obvious instrumentation failure or loss of correction.

This study suggests that allograft bone graft is a suitable substitute for autogenous bone graft harvesting in select patients with paralysis in whom autogenous harvesting is not feasible.