Allograft Bone in Spinal Fusion for Adolescent Idiopathic Scoliosis

Knapp, D. Raymond; Jones, Eric T.; Blanco, John S.; Flynn, Joseph C.; Price, Charles T.

doi:10.1097/01.bsd.0000128694.21405.80

Cited by 37 publications

(27 citation statements)

References 23 publications

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“…16,17,23 Despite this, our data support the study by Sponseller and colleagues, 4 identifying the use of allograft as a significant risk factor within the entire cohort and when adjusted for effect modifiers (e.g., nonidiopathic or neuromuscular diagnoses). The reasons for this finding are not clear, but may include the overwhelming of host defenses by the presence of a large amount of devitalized bone in patients who were already relatively immunocompromised.…”

supporting

confidence: 36%

“…15 The use of allograft has also been suggested to increase the risk of infection, but this conclusion remains controversial. 4,16,17 The diagnosis of infection is difficult to establish but is suggested by pain, 18 the presence of a sinus tract, persistent or late postoperative wound drainage, erythema, wound dehiscence, positive culture from a wound aspirate, instrumentation failure/pseudoarthrosis and pathologic confirmation of the presence of inflammatory cells and/or the offending organism(s). 1,3,5,6,19 Staphylococcus aureus 1,12,15 and S. epidermidis 2,5,20 have been reported to be the most common causative organisms.…”

mentioning

confidence: 99%

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Deep wound infection following pediatric scoliosis surgery: incidence and analysis of risk factors

Aleissa¹

2011

Can J Surg

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Background:Deep wound infection after spinal surgery is a severe complication that often requires prolonged medical and surgical management. It can compromise the outcome of the deformity correction, especially in patients requiring surgical intervention with subsequent removal of implants. Ascertaining the incidence and risk factors leading to infection may help to prevent this problem. Methods:We reviewed the hospital charts of all patients who underwent spinal deformity correction from 1996 to 2005. Results:In all, 227 patients were identified (139 idiopathic, 57 neuromuscular, 8 syndromic, 6 congenital, 17 other); 191 patients were treated with posterior instrumentation and fusion, 11 with anterior-only procedures and 24 with combined anterior and posterior procedures. Final follow-up ranged from 1 to 9.5 years. Infection developed in 14 patients. The overall incidence of infection was 6.2%. Drainage and back pain were the most common presenting symptoms. The incidence of infection was higher among patients with nonidiopathic diagnoses (risk ratio [RR] 8.65, p < 0.001). Use of allograft bone was associated with a higher rate of infection (RR 9.66, p < 0.001) even when stratified by diagnosis (nonidiopathic diagnoses, RR 7.6, p = 0.012). Higher volume of instrumentation was also a risk factor for infection (p = 0.022). Coagulasenegative Staphyloccocus was the most commonly identified organism, followed by Propionibacterium acnes and Pseudomonas. Conclusion:Development of infection following scoliosis surgery was found to be associated with several risk factors, including a nonidiopathic diagnosis, the use of allograft and a higher volume of instrumentation. Preventative measures addressing these factors may decrease the rate of infection.Contexte : L'infection profonde de la plaie après une intervention chirurgicale à la colonne est une complication grave qui nécessite souvent un traitement médical et chirurgical prolongé. L'infection peut compromettre le résultat de la correction d'une malformation, surtout chez les patients qui doivent subir une autre intervention chirurgicale pour retirer des implants. La détermination de l'incidence et des facteurs de risque d'infection pourrait aider à éviter le problème.Méthodes : Nous avons examiné les dossiers d'hôpital de tous les patients qui ont subi, de 1996 à 2005, une intervention chirurgicale à la colonne visant à corriger une malformation.

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confidence: 36%

mentioning

confidence: 99%

Deep wound infection following pediatric scoliosis surgery: incidence and analysis of risk factors

Aleissa¹

2011

Can J Surg

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“…It had the added advantage of avoiding donor site morbidity and increased blood loss (Banwart et al 1995;Cockin 1971;Kreibich et al 1994;Summers and Einstein 1989). This is in support of other studies that have observed that cancellous allograft is effective in achieving spinal fusion (Knapp et al 2005;Lobo Gajiwala et al 2003;Marczynski et al 1999).…”

Section: Discussionsupporting

confidence: 68%

The use of irradiated allograft in a paediatric population: an Indian experience

Johari¹,

Shingade²,

Gajiwala

et al. 2006

Cell Tissue Banking

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Lyophilised, irradiated bone allografts available for the first time in the country from the Tata Memorial Hospital Tissue Bank were used in 30 paediatric patients from January 2001 to August 2004. They included 20 patients of scoliosis of various origin and ten with assorted orthopaedic conditions including one congenital kyphosis, two Pott's spine, one Perthes disease, one developmental dysplasia of the hip (DDH), one infective non-union, one fibrous dysplasia and three with bone defects either due to trauma, a cyst or removal of hardware. Morsellised allograft was used in 28 patients. In those cases of scoliosis in which ribs were resected out during costectomy, the morsellised allograft was mixed with morsellised rib autograft. Non-morsellised femoral head grafts were used in two patients, one a case of varus open derotation osteotomy in Perthes disease and the other an acetabuloplasty in DDH. Patients were followed at intervals of 8-12 weeks and radiological evaluation was done periodically. The follow up period ranged from 1 to 4 years post surgery. All patients with scoliosis showed excellent union at the grafting site with non-progression of curve and no signs of loosening at implant site. The two patients, in whom non-morsellised femoral head grafts were used, both showed incorporation of the graft with good fusion within a 4 month period. None of the patient had infection, non-union, pseudoarthrosis, fracture at the graft site, or any other complication.

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“…With the minimum follow up of 3 years, no loss of correction or pseudarthrosis was identified. Studies have also shown allograft bone to be as effective as autograft bone in posterior spinal fusion [5,10]. In our study, we found the combination of autograft and allograft bone provided good results in the treatment of AIS, i.e., no failure of fusion were seen on radiographs, percent correction was well maintained, and no patients complained of back pain.…”

Section: Discussionsupporting

confidence: 66%

“…The high morbidity of iliac crest bone graft harvesting has limited its application. Allograft bone has the advantages of adequate supply and variety of type, and reports indicate that allograft bone is a suitable alternative to autogenous bone grafting for AIS corrective surgical procedures [4,5]. …”

Section: Introductionmentioning

confidence: 99%

Clinical and radiographic outcomes of the treatment of adolescent idiopathic scoliosis with segmental pedicle screws and combined local autograft and allograft bone for spinal fusion: a retrospective case series

Yang

et al. 2010

BMC Musculoskelet Disord

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BackgroundHigh morbidity has been reported with iliac crest bone graft harvesting; however, donor bone is typically necessary for posterior spinal fusion. Autograft bone combined with allograft may reduce the morbidity associated with iliac crest bone harvesting and improve the fusion rate. Our aim in this study was to determine the presence of complications, pseudarthrosis, non-union, and infection using combined in situ local autograft bone and freeze-dried cancellous allograft bone in patients undergoing posterior spinal fusion for the treatment of adolescent idiopathic scoliosis.MethodsA combination of in situ local autograft bone and freeze-dried cancellous allograft blocks were used in 50 consecutive patients with adolescent idiopathic scoliosis treated by posterior fusion and Moss Miami pedicle screw instrumentation. Results were assessed clinically and radiographically and quality of life and functional outcome was evaluated by administration of a Chinese version of the SRS-22 survey.ResultsThere were 41 female and 9 male patients included for analysis with an average age of 14.7 years (range, 12-17). All patients had a minimum follow-up of 18 months (range, 18 to 40 months). The average preoperative Cobb angle was 49.8° (range, 40° to 86°). The average number of levels fused was 9.8 (range, 6-15). Patients had a minimum postoperative follow-up of 18 months. At final follow-up, the average Cobb angle correction was 77.8% (range, 43.4 to 92.5%). There was no obvious loss in the correction, and the average loss of correction was 1.1° (range, 0° to 4°). There was no pseudarthrosis and no major complications.ConclusionsIn situ autograft bone combined with allograft bone may be a promising method enhances spinal fusion in AIS treated with pedicle screw placement. By eliminating the need for iliac crest bone harvesting, significant morbidity may be avoided.

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Allograft Bone in Spinal Fusion for Adolescent Idiopathic Scoliosis

Abstract: Pseudarthrosis rate of 2.7% and loss of correction of 5.9% are comparable with or better than those in previous reports using autogenous bone graft and either segmental or nonsegmental instrumentation.

Cited by 37 publications

References 23 publications

Deep wound infection following pediatric scoliosis surgery: incidence and analysis of risk factors

Deep wound infection following pediatric scoliosis surgery: incidence and analysis of risk factors

The use of irradiated allograft in a paediatric population: an Indian experience

Clinical and radiographic outcomes of the treatment of adolescent idiopathic scoliosis with segmental pedicle screws and combined local autograft and allograft bone for spinal fusion: a retrospective case series

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