Iliac Crest Bone Graft

An Investigation of Post-Operative Morbidity Following Iliac Crest Graft Harvesting

September 7  |  Articles, DBM's, Stem Cell  |   admin

Objectives
A study which examined the morbidity experienced by patients who underwent iliac crest bone graft procedures.

Design A post-operative questionnaire was forwarded to patients who underwent iliac crest bone graft procedures at a single centre.

Subjects One hundred and fourteen patients underwent iliac crest bone grafts for intra-oral augmentation.

Results Ninety-eight patients (80%) returned post-operative questionnaires. Eighty of the 98 (81.6%) patients suffered post-operative pain with 70% of patients being pain-free after four weeks. However, 10% of patients experienced pain for more than 16 weeks. Eighty-five (86.7%) patients were able to walk without any difficulties six weeks post-operatively. Gait disturbance was not related with age, however there was a significant association between pain and disturbance of gait (P< 0.001). Twenty two patients required the use of a walking stick and the use of such aids varied from 0.5 to 26 weeks. Women used walking aids for longer periods than men (P< 0.05). Twenty five patients had altered sensation with about half of them experiencing altered sensation in the distribution of the lateral femoral cutaneous nerve. Other morbidities included deformity at the hip site (2.4%), haematoma (2.4%), infection (3.2%), stress fracture (4.1%) and meralgia paraesthetica in one patient. Despite the above morbidities, 82 patients were willing to undergo the same procedure again and 89 patients would recommend the procedure to their relatives and friends.

A. Joshi and G. C. Kostakis. An investigation of post-operative morbidity following iliac crest graft harvesting.

Continue Reading

Tagged , , , , ,

Complications of Iliac Crest Bone Graft Harvesting

September 7  |  Articles, DBM's, Stem Cell  |   admin

Abstract
Autologous bone grafts harvested from the iliac crest are commonly used in reconstructive orthopaedic surgery. Autologous bone is used to help promote bone healing in fractures and to provide structural support for reconstructive surgery. The results of autologous bone grafting are more predictable than the use of xenografts, cadaveric allografts, or synthetic bone substitutes because autologous bone grafts provide osteoinductive and osteoconductive properties, are not immunogenic, and are usually well incorporated into the graft site. In a retrospective review of 414 consecutive cases of iliac crest bone graft procedures performed at Brooke Army Medical Center from 1983 to 1993, 41 (10%) minor and 24 (5.8%) major complications were identified. Minor complications included superficial infections, superficial seromas, and minor hematomas. Major complications included herniation of abdominal contents through massive bone graft donor sites, vascular injuries, deep infections at the donor site, neurologic injuries, deep hematoma formation requiring surgical intervention, and iliac wing fractures. Harvesting of iliac crest bone graft can be associated with significant morbidity. However, with adequate preoperative planning and proper surgical technique, the incidence of these complications can be reduced.

2. Arrington ED, Smith WJ, Chambers HG, Bucknell AL, Davino NA. Complications of iliac crest bone graft harvesting, Clin Orthop Relat Res. 1996 Aug ;( 329):300-9.

Continue Reading

Tagged , , , , ,

Use of patella allograft for anterior cervical diskectomy and fusion

April 25  |  Articles, Spine  |   admin

Department of Orthopaedic Surgery and Rehabilitation, University of Wisconsin, Madison, WI 53792, USA.

Abstract

STUDY DESIGN: Retrospective cohort.

OBJECTIVE: The purpose of this study is to determine the fusion rates of a consecutive series of anterior cervical decompressions and fusions with allograft patella using both static and dynamic plates.

SUMMARY OF BACKGROUND DATA: Anterior cervical diskectomy and fusion (ACDF) has been shown to improve symptoms of radiculopathy and myelopathy. The gold standard for obtaining fusion is using autogenous iliac crest bone graft (ICBG). The complication rate of using ICBG can be as high as 20%. To minimize this morbidity, various forms of allograft are presently used. We have used patellar allograft that we hypothesize exhibits a good combination of strength and sufficient porosity to facilitate fusion.

METHODS: A consecutive series of 179 levels in 136 patients who underwent single and multilevel ACDF with allograft patella were retrospectively investigated. Final follow-up lateral cervical spine radiographs were evaluated for evidence of bony fusion. Fusions were graded independently by 2 of the investigators according to an interbody fusion classification proposed by Bridwell and colleagues, Spine, 1995. Fusion rates were compared with historical controls for single-level ACDF with autogenous ICBG and plating. Multivariate analysis was used to evaluate plate type, smoking, revision rate, and Odom’s criteria compared with fusion.

RESULTS: Ninety-one consecutive single and 81 multilevel anterior cervical decompression and fusions with allograft patella were reviewed. Demographics were similar (average age 47.75 y). Average follow-up was 19.3 months. Fusion rates were 86% (159/179). Our revision rate was 8%. Eighty-one percent (85/98) union rate was noted in the single-level group, and 85% (69/81 levels) or 74% (28/38 patients) in the multilevel group.

CONCLUSIONS: Fusion rates were 86%. Plate design (static vs. dynamic) did not seem to affect fusion rates or clinical outcomes. There was a higher nonunion rate at the most inferior level of the multilevel fusions. Nonunions in the dynamic group were more commonly revised and had more kyphosis at final follow-up.

Spine (Phila Pa 1976). 1999 May 1;24(9):852-8; discussion 858-9.

Continue Reading

Tagged , , , , ,

Augmentation Of Rabbit Posterolateral Spondylodesis Using a Novel Demineralized Bone Matrix-hyaluronan Putty

February 16  |  Articles, DBM's  |   admin

Abstract

STUDY DESIGN: Posterolateral spinal fusion with allogeneic demineralized bone graft-hyaluronan putty in addition to autogenous iliac crest bone graft in a rabbit model.

OBJECTIVES: To determine the potential efficacy of demineralized bone graft-hyaluronan putty as a bone graft enhancer.

SUMMARY OF BACKGROUND DATA: Autograft bone is the material of choice for posterolateral lumbar intertransverse process fusion. Bone graft alternatives such as demineralized bone matrices that can be used as graft extenders, enhancers, or substitutes continue to be developed.

METHODS: One hundred New Zealand white rabbits underwent bilateral posterolateral spinal fusion with autogenous iliac crest bone graft or bone graft with allogeneic rabbit demineralized bone graft-hyaluronan putty. The rabbits were killed 9 weeks later, and the lumbar spines were removed. Manual manipulation and fine detail radiography were used to assess spinal fusion, and computed tomographic images were used to quantify the volume of the fusion mass.

Yee, A.J., et al., Augmentation of rabbit posterolateral spondylodesis using a novel demineralized bone matrix-hyaluronan putty. Spine, 2003. 28(21): p. 2435-40, 2003

Continue Reading

Tagged , , , , ,