6-Year follow-up of ventral monosegmental spondylodesis of incomplete burst fractures of the thoracolumbar spine using three cortical iliac crest bone grafts.
BACKGROUND
Autologous bone graft is the gold standard for vertebral body replacement. Currently, after modern implants for vertebral body replacement are available, controversies exist regarding the optimal implant strategy.


METHODS
Between 2002 and 2003, 17 patients were included in this study, all suffering from incomplete burst fractures of the thoracolumbar spine. All of them were treated by ventral monosegmental spondylodesis using iliac crest bone graft. The individual treatment strategy depended on the fracture situation and patient's condition. After an average of 74 months (range 66-84) a clinical and computer tomographic follow-up examination was performed in 14 patients (average age, 35.2 years) including VAS spine score and SF 36 score. Nine patients were treated ventral only five patients dorsoventrally.


RESULTS
Complete osseous consolidation was visible in nine, partial consolidation (>30 %) in four, and lysis in one patient, without any significant differences between ventral only or dorsoventral approach. After removal of the fixateur interne the level of consolidation improved in all patients, treated dorsoventrally. There was no significant correlation between percentage of osseous consolidation and the clinical follow-up parameters. After 6 years, 71 % of the patients suffered from persistent pain associated with the approach to the iliac crest. Two revision surgeries have been necessary.


CONCLUSIONS
High rates of osseous consolidation are visible 6 years after ventral spondylodesis by iliac crest bone grafts. A further improvement of consolidation can be expected after dorsal implant removal. But the surgical approach to the iliac crest is accompanied with a relevant complication rate.
Berufsgenossenschaftliche Unfallklinik Murnau, Trauma Center, Prof. Küntscherstr. 8, 82418 Murnau, Germany. UlrichJosefAlbert.Spiegl@medizin.unileipzig.de
Ulrich
U
Spiegl
Stefan
S
Hauck
Patricia
P
Merkel
Volker
V
Bühren
Oliver
O
Gonschorek
D000328:Adult; D016025:Bone Transplantation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007085:Ilium / Q000637:transplantation; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D016103:Spinal Fractures / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D013904:Thoracic Vertebrae; D055815:Young Adult