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

Abstract

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.

Clinical Feasibility of Completely Autologous Fibrin Glue in Spine Surgery

“…In this respect, the results of the present study are intriguing. However, it would be premature to arrive at the conclusion regarding the effect of CAFG on bone fusion, because the present study is based on the analysis of implant failure detected on plain radiography similar to previous studies instead of directly assessing bone fusion on CT 30,31) . Although CT is widely accepted as the gold standard for the assessment of bone fusion, it is not recommended to routinely take CT for the assessment of bone fusion, especially in young patients following fusion surgery for idiopathic scoliosis, because CT inevitably causes high radiation exposure in patients 21) .…”

Comparison between harvesting and preserving the spinous process for adolescent idiopathic scoliosis

“…In 2004, Violas et al [ 7 ] first proposed using only local autologous bone graft in AIS posterior fusion with pedicle screw instrumentation and reported good outcomes. In addition, Yang et al [ 16 ] reported the combination of local autologous bone graft and allograft yielded no failure of fusion in AIS patients receiving posterior fusion with pedicle screw instrumentation. In AIS surgery, local autologous bone graft has been shown to achieve comparable fusion results to iliac crest bone graft in the past 10 years, and has been recommended for the optimal surgical care of patients undergoing AIS [ 8 ].…”

Bone Graft Options for Spine Fusion in Adolescent Patients with Idiopathic Scoliosis

“…Less loss of correction was described in patients undergoing pedicle screw system compared with those undergoing Cotrel-Dubousset or Harrington instrumentation (1.1 vs. 5.9 or 6.5°, respectively). [ 15 ]…”