Synthetic porous ceramic compared with autograft in scoliosis surgery: A prospective, randomised study of 341 patients

Abstract

We have evaluated the use of a synthetic porous ceramic (Triosite) as a substitute for bone graft in posterior spinal fusion for idiopathic scoliosis. In a prospective, randomised study 341 patients at five hospitals in the UK and France were randomly allocated either to autograft from the iliac crest or rib segments (171) or to receive Triosite blocks (170). All patients were assessed after operation and at 3, 6, 12 and 18 months. The two groups were similar with regard to all demographic and baseline variables, but the 184 treated in France (54%) had Cotrel-Dubouset instrumentation and the 157 treated in the UK usually had Harrington-Luque implants. In the Triosite group the average Cobb angle of the upper curve was 56 degrees, corrected to 24 degrees (57%). At 18 months, the average was 26 degrees (3% loss). In the autograft group the average preoperative upper curve of 53 degrees was corrected to 21 degrees (60%). At 18 months the mean curve was 25 degrees (8% loss). Pain levels after operation were similar in the two groups, being mild in most cases. In the Triosite group only three patients had problems of wound healing, but in the autograft group, 14 patients had delayed healing, infection or haematoma in the spinal wound. In addition, 15 autograft patients had pain at the donor site at three months. Seven had infections, two had haematoma and four had delayed healing. The haematological and serum biochemistry results showed no abnormal trends and no significant differences between the groups. There were no adverse events related to the graft material and no evidence of allergenicity. Our results suggest that Triosite synthetic porous ceramic is a safe and effective substitute for autograft in these patients. Histological findings on biopsy indicate that Triosite provides a favourable scaffolding for the formation of new bone and is gradually incorporated into the fusion mass.

Substitutos ósseos comparados ao enxerto ósseo autólogo em cirurgia ortopédica: revisão sistemática da literatura

“…Nos estudos de Burkus et al e de Korovessis et al foram utilizados cilindros de titânio impregnado de BMP-2 e esponja de colágeno (6,18) . Nos estudos de Ransford et al e de Burkus et al foram utilizadas cavilhas de osso homólogo associado a BMP-2 e esponja de colágeno (14,17) . Todos são trabalhos realizados no mesmo centro (The Hughston Clinic, Columbus, Georgia, Estados Unidos), coordenados pelo mesmo pesquisador (Burkus et al), publicados entre 2002 e 2005, com critérios claros de documentação e randomização.…”

“…Dickson et al (13) 11 Synthetic porous ceramic compared with autograft in scoliosis surgery. A prospective, Ransford et al (14) randomized study of 341 patients.…”

“…envolvendo BMP-2 (5)(6)9,15,17,(20)(21) , três utilizando BMP-7 (10)(11)19) , sete envolvendo biocerâmicas, como hidroxiapatita, fosfato tricálcio e sulfato de cálcio (12)(13)(14)16,18,(22)(23) . O substituto ósseo mostrou-se equivalente ao enxerto autólogo em 19 estudos (4)(5)(6)(7)(8)(9)(10)(11)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) e inferior em três (12,(24)(25) .…”

“…O substituto ósseo mostrou-se equivalente ao enxerto autólogo em 19 estudos (4)(5)(6)(7)(8)(9)(10)(11)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) e inferior em três (12,(24)(25) .…”

“…Dos 22 artigos, 19 fizeram referência a cirurgias da coluna vertebral (4)(5)(6)(7)(8)(9)(10)(14)(15)(17)(18)(19)(20)(21)(22)(23)(24)(25) e três a cirurgias do esqueleto apendicular (11,13,16) , fazendo com que todos os 22 trabalhos fossem considerados em conjunto, sem distinção entre os diferentes tipos de esqueleto.…”