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Guidelines to decortication in posterolateral spine fusion
G Slappey1, Y Toribatake, T M Ganey
1The Georgia Baptist Medical Center, Atlanta 30312, USA.
Journal of Spinal Disorders
|May 20, 1998
Summary
Understanding spinal fusion vascularity is key to improving outcomes. Decorticating transverse processes and lateral facets enhances fusion, while the pars interarticularis is less suitable due to its dense bone structure.
Area of Science:
- Orthopedic Surgery
- Spinal Fusion
- Vascular Anatomy
Background:
- Spinal fusion nonunion rates can reach 35%, impacting patient outcomes.
- Decortication enhances fusion by providing vascular supply and stem cells.
- Limited understanding exists regarding the vascular anatomy of decorticated spinal regions.
Purpose of the Study:
- To delineate the vascular anatomy involved in posterolateral spinal fusion decortication.
- To identify optimal decortication sites for improved spinal fusion success.
- To understand the implications of bone architecture on fusion outcomes.
Main Methods:
- Cadaver spines were perfused with radiopaque contrast material.
- Specimens underwent fixation, decalcification, and Spalteholz clearing.
- Vascular supply was documented through transverse, sagittal, and coronal slabs.
Main Results:
- Vertebral intraosseous architecture is predominantly cancellous with sinusoidal blood distribution.
- The pars interarticularis exhibits a denser, cortical bone architecture with haversian lamellar bone.
- Transverse processes and lateral facets show vascularity suitable for decortication.
Conclusions:
- Posterolateral intertransverse process arthrodesis benefits from decorticating transverse processes and lateral facets.
- The pars interarticularis is a less attractive site for decortication due to its bone structure.
- Understanding regional bone vascularity is crucial for optimizing spinal fusion techniques.