Relationship between autologous bone graft osteointegration and correction loss after antero-posterior spondylodesis of traumatic vertebral body fracture

Mar 5, 2015Orthopaedics & traumatology, surgery & research : OTSR

Link between patient’s own bone graft healing and loss of correction after front-to-back spinal fusion for broken vertebra

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Abstract

Mean vertebral wedge angle changed by 2.1° after surgery in 142 patients with unstable vertebral body fractures.

Postoperative changes in the vertebral wedge angle, segmental kyphotic angle, and adjusted segmental kyphotic angle were statistically significant (P<0.05).
The McAfee fusion assessment indicated that 64% of cranial grafts achieved full fusion, while 47% of caudal grafts did.
Partial fusion was observed in 20.5% of cranial grafts and 29% of caudal grafts.
A total of 8.5% of cranial grafts and 17% of caudal grafts showed signs of lysis.
No correlation was found between angle changes and the grades of fusion, suggesting limited impact of fusion extent on correction loss.

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BACKGROUND: A common method to restore the sagittal alignment and stabilize the spinal column is a dorso-ventral spondylodesis. It is assumed that correction loss after posttraumatic spondylodesis results from inadequate incorporation of the autologous iliac crest graft.

MATERIALS AND METHODS: Retrospective documentation of patients with unstable vertebral body fractures of the thoracic or lumbar spine with concomitant rupture of at least one adjacent intervertebral disk who received surgical treatment at our institution from 2000 to 2006. Followed by analysis of the computer tomography documentation of a total of 142 patients with unstable vertebral body fracture stabilized by posterior internal fixator and anterior iliac crest spondylodesis.

RESULTS: The following mean angle changes were derived from the second series of CT scans performed on average 283 days after anterior spondylodesis: vertebral wedge angle (VWA): 2.1°; segmental kyphotic angle: 4.9°; adjusted-SKA: 4.8°; sagittal index (SI): -0.04; segmental-scoliotic-angle (SSA): 0°; adjusted-SSA: 0°. Changes in VWA, both SKAs and SI postoperatively and prior to ME, were statistically significant (P<0.05). The McAfee fusion assessment of the graft showed: full fusion: cranial 64%, caudal 47%; partial fusion: cranial 20.5%, caudal 29%; lysis: cranial 8.5%, caudal 17%; graft resorption: 7%. No correlation was found between the above-mentioned angle changes and fusions grade.

DISCUSSION: The importance of radiological evidence of fusion deficiency is questionable, because the extent of fusion only has a minimal effect on correction loss.

LEVEL OF EVIDENCE: Level IV.

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Relationship between autologous bone graft osteointegration and correction loss after antero-posterior spondylodesis of traumatic vertebral body fracture

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