title: Anterior instrumentation for thoracolumbar adolescent idiopathic scoliosis: do structural interbody grafts preserve sagittal alignment better than morselized rib autografts?
abstract: METHODS
  This is a retrospective, sequential cohort study of 34 patients treated by anterior instrumented fusion with single solid rod, single screw constructs with at least 2-year follow-up. Sixteen of the patients received structural grafts as interbody spacers in disc levels below T12, while the other 18 patients received only morselized rib autograft.
  
  
  OBJECTIVE
  To determine if structural interbody grafts preserve sagittal alignment better than morselized rib autograft.
  
  
  BACKGROUND
  Some studies have shown that structural grafts are more effective in preserving sagittal alignment, while others have found them to be no more effective than morselized rib graft.
  
  
  METHODS
  Anterior-posterior radiographs were measured for primary, secondary, and fractional Cobb curves, and C7-sacrum plumb lines. Lateral radiographs were measured for: T5-HIV (highest instrumented vertebrae), instrumented levels, LIV (lowest instrumented vertebrae)-S1, T12-LIV, and T12-S1 angles, C7-sacrum plumb lines, and LID-A (lowest instrumented disc-angle).
  
  
  RESULTS
  The increase in kyphosis from preoperative to follow-up radiographs of the angle between T12-LIV was significantly more for the patients with morselized rib graft compared with those with structural grafts, 9 degrees and 1 degree, respectively (P < 0.05).
  
  
  CONCLUSIONS
  The structural grafts placed in disc spaces below T12 were able to maintain sagittal alignment over this region, while the spines that received only morselized rib graft collapsed into kyphosis.
authors.affiliation: Los Angeles Spine Surgery Institute, Los Angeles, CA 90057, USA. robertwatkinsmd@yahoo.com
authors.forename: Robert G
authors.initials: RG
authors.lastname: Watkins
authors.forename: Nazakat
authors.initials: N
authors.lastname: Hussain
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Freeman
authors.forename: Michael P
authors.initials: MP
authors.lastname: Grevitt
authors.forename: John K
authors.initials: JK
authors.lastname: Webb
mesh_terms: D000293:Adolescent; D000328:Adult; D001672:Biocompatible Materials; D001858:Bone Nails; D018786:Bone Substitutes; D016025:Bone Transplantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011859:Radiography; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D014184:Transplantation, Homologous
chemical_list: D001672:Biocompatible Materials; D018786:Bone Substitutes