Allograft versus autograft bone in scoliosis surgery

Dodd, Caf; Fergusson, C. M.; Freedman, Leonard; Houghton, G. R.; Thomas, D. T.

doi:10.1302/0301-620x.70b3.3286656

Cited by 126 publications

(37 citation statements)

References 10 publications

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“…A number of authors reported significant lower blood loss and reduced operative time using synthetic bone graft substitutes or allograft instead of ICBG [3,12,17]. Compared to the ICBG group, operative time in the b-TCP group was slightly reduced by 10 min though not statistically significant.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, a number of authors advocate allograft augmentation to achieve successful spinal fusion, reporting comparable results to the use of autograft [3,6,12,14,17,20]. Concerns, however, exist regarding the efficacy of frozen or freeze dried allograft, the potential of immunogenicity, and the hazard of microbial contamination, though the rate of disease transmission has proven to be low [1,13,24,26,47].…”

Section: Introductionmentioning

confidence: 99%

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A level-1 pilot study to evaluate of ultraporous β-tricalcium phosphate as a graft extender in the posterior correction of adolescent idiopathic scoliosis

et al. 2008

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The objective of this study is to compare the clinical and radiographic results of ultraporous b-tricalcium phosphate (b-TCP) versus autogenous iliac crest bone graft (ICBG), through prospective randomized pilot study (EBM-Level 1), as graft extenders in scoliosis surgery. In the posterior correction of scoliosis, local bone resected as part of the procedure is used as the base bone graft material. Supplemental grafting from the iliac crest is considered the gold-standard in posterior spinal fusion. However, autograft is not available in unlimited quantities, and bone harvesting is a source of significant morbidity. Ultraporous b-TCP might be a substitute for ICBG in these patients and thus eliminate donor site morbidity. A total of 40 patients with adolescent idiopathic scoliosis (AIS) were randomized into two treatment groups and underwent corrective posterior instrumentation. In 20 patients, ICBG harvesting was performed whereas the other half received b-TCP (VITOSS Ò ) to augment the local bone graft. If thoracoplasty was performed, the resected rib bone was added in both groups. Patients were observed clinically and radiographically for a minimum of 20 months postoperatively, with a mean follow-up of 4 years. Overall pain and pain specific to the back and donor site were assessed using a visual analog scale (VAS). As a result, both groups were comparable with respect to the age at the time of surgery, gender ratio, preoperative deformity, and hence length of instrumentation. There was no significant difference in blood loss and operative time. In nine patients of the b-TCP group and eight patients of the ICBG group, thoracoplasty was performed resulting in a rib graft of on average 7.9 g in both groups. Average curve correction was 61.7% in the b-TCP group and 61.2% in the ICBG group at hospital discharge (P = 0.313) and 57.2 and 54.3%, respectively, at follow-up (P = 0.109). Loss of curve correction amounted on average 2.6°in the b-TCP group and 4.2°in the comparison group (P = 0.033). In the ICBG group, four patients still reported donor site pain of on average 2/10 on the VAS at last follow-up. One patient in the b-TCP group was diagnosed with a pseudarthrosis at the caudal end of the instrumentation. Revision surgery demonstrated solid bone formation directly above the pseudarthrosis with no histological evidence of b-TCP in the biopsy taken. In conclusion, the use of b-TCP instead of ICBG as extenders of local bone graft yielded equivalent results in the posterior correction of AIS. The promising early results of this pilot study support that b-TCP appears to be an effective bone substitute in scoliosis surgery avoiding harvesting of pelvic bone and the associated morbidity.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A level-1 pilot study to evaluate of ultraporous β-tricalcium phosphate as a graft extender in the posterior correction of adolescent idiopathic scoliosis

et al. 2008

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“…However, there are no studies which demonstrate superiority of one graft material over another. The uncontrolled studies of Dodd et al [48] and Ilharreborde et al [49] support the recommendation that autologous ICBG is no longer the routinely used graft for spine fusion in AIS patients. There is no evidence which evaluates the effectiveness of BMP use in AIS patients, yet there is evidence to indicate its use in pediatric spinal fusions is increasing [50].…”

Section: Supporting Empirical Evidencementioning

confidence: 92%

Optimal surgical care for adolescent idiopathic scoliosis: an international consensus

et al. 2014

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Purpose The surgical management of adolescent idiopathic scoliosis (AIS) has seen many developments in the last two decades. Little high-level evidence is available to support these changes and guide treatment. This study aimed to identify optimal operative care for adolescents with AIS curves between 40°and 90°Cobb angle. Methods From July 2012 to April 2013, the AOSpine Knowledge Forum Deformity performed a modified Delphi survey where current expert opinion from 48 experienced deformity surgeons, representing 29 diverse countries, was gathered. Four rounds were performed: three web-based surveys and a final face-to-face meeting. Consensus was achieved with C70 % agreement. Data were analyzed qualitatively and quantitatively.Results Consensus of what constitutes optimal care was reached on greater than 60 aspects including: preoperative radiographs; posterior as opposed to anterior (endoscopic) surgical approaches; use of intraoperative spinal cord monitoring; use of local autologous bone (not iliac crest) for grafts; use of thoracic and lumbar pedicle screws; use of titanium anchor points; implant density of \80 % for 40°-70°curves; and aspects of postoperative care. Variability in practice patterns was found where there was no consensus. In addition, there was consensus on what does not constitute optimal care, including: routine pre-and intraoperative traction; routine anterior release; use of bone morphogenetic proteins; and routine postoperative CT scanning. operative care for adolescents with AIS. In the absence of current high-level evidence, at present, these expert opinion findings will aid health care providers worldwide define appropriate care in their regions. Areas with no consensus provide excellent insight and priorities for future research.

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“…9 Allogeneic bone graft is usually the 2nd choice for clinical bone replacement. 10 The off-the-shelf availability and lack of donor site morbidity are undisputed advantages of the allograft. 11,12 Fresh, frozen, and freeze-dried allografts are seemed to be the most popular, however, there is not a well-established protocol for their manufacture.…”

mentioning

confidence: 99%

Freeze‐dried human serum albumin improves the adherence and proliferation of mesenchymal stem cells on mineralized human bone allografts

Weszl

Skaliczki

Cselenyák

et al. 2011

Journal Orthopaedic Research

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Mineralized scaffolds are widely used as bone grafts with the assumption that bone marrow derived cells colonize and remodel them. This process is slow and often unreliable so we aimed to improve the biocompatibility of bone grafts by pre-seeding them with human mesenchymal stem cells from either bone marrow or dental pulp. Under standard cell culture conditions very low number of seeded cells remained on the surface of freeze-dried human or bovine bone graft or hydroxyapatite. Coating the scaffolds with fibronectin or collagen improved seeding efficiency but the cells failed to grow on the surface until the 18th day. In contrast, human albumin was a very potent facilitator of both seeding and proliferation on allografts which was further improved by culturing in a rotating bioreactor. Electron microscopy revealed that cells do not form a monolayer but span the pores, emphasizing the importance of pore size and microstructure. Albumin coated bone chips were able to unite a rat femoral segmental defect, while uncoated ones did not. Micro-hardness measurements confirmed that albumin coating does not influence the physical characteristics of the scaffold, so it is possible to introduce albumin coating into the manufacturing process of lyophilized bone allografts. ß

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Allograft versus autograft bone in scoliosis surgery

Abstract: The results of a study of the use of autograft versus allograft bone in the surgery of idiopathic adolescent scoliosis are presented.

Cited by 126 publications

References 10 publications

A level-1 pilot study to evaluate of ultraporous β-tricalcium phosphate as a graft extender in the posterior correction of adolescent idiopathic scoliosis

A level-1 pilot study to evaluate of ultraporous β-tricalcium phosphate as a graft extender in the posterior correction of adolescent idiopathic scoliosis

Optimal surgical care for adolescent idiopathic scoliosis: an international consensus

Freeze‐dried human serum albumin improves the adherence and proliferation of mesenchymal stem cells on mineralized human bone allografts

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