title: A therapeutic efficacy of the transpedicular intracorporeal bone graft with short-segmental posterior instrumentation in osteonecrosis of vertebral body: a minimum 5-year follow-up study.
abstract: METHODS
  A retrospective review of clinical and radiological parameters.
  
  
  OBJECTIVE
  The purpose of this study was to investigate the therapeutic efficacy of transpedicular intracorporeal bone graft (IBG) in osteonecrosis of vertebral body (ONV) for 5-years follow-up period.
  
  
  BACKGROUND
  Although a broad spectrum of surgical options has been described for the treatment of ONV without neurological deficits, no effective treatment has been definitely established. Limited previous work has reported favorable outcomes with IBG; however, these studies were limited by short-term follow-up and small sample sizes. This study is the first to report the clinical and radiological results of IBG with short-segmental posterior instrumentation in ONV with a 5-year follow-up period.
  
  
  METHODS
  Thirty-six patients were followed for at least 5 years after transpedicular IBG with short-segmental posterior instrumentation. We retrospectively reviewed outcomes, including visual analogue scale score, the Oswestry Disability Index score, compression ratio, and kyphotic angle.
  
  
  RESULTS
  There were 11 complications, including pneumonia in 4 patients, screw loosening in 5 patients, mild hematoma at the subcutaneous tissue in 1 case, and pseudarthrosis in 1 case. The mean visual analogue scale score was exhibiting V-shaped upward trend after postoperative 6 months that ended with the almost similar score obtained with preoperative status. The mean Oswestry Disability Index score was also shown with similar trend. In functional score, there was a statistical significant improvement until only 6 months after surgery. In radiological evaluation, the mean kyphotic angle and compression ratio was significantly corrected after surgery (P < 0.05). However, these improved radiological parameters were maximal at the immediate postoperative time with gradual loss over time.
  
  
  CONCLUSIONS
  Transpedicular IBG with short-segmental posterior instrumentation may lead to complications such as prolonged back pain and recurrence of kyphotic deformity in the 5 years after the procedure. Therefore, we do not recommend short-segmental posterior instrumentation concurrently with transpedicular IBG for treating ONV.
  
  
  METHODS
  4.
authors.affiliation: Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Bundang-gu, Sungnam, Republic of Korea.
authors.forename: Gun Woo
authors.initials: GW
authors.lastname: Lee
authors.forename: Jin S
authors.initials: JS
authors.lastname: Yeom
authors.forename: Ho-Joong
authors.initials: HJ
authors.lastname: Kim
authors.forename: Bo-Gun
authors.initials: BG
authors.lastname: Suh
mesh_terms: D000368:Aged; D001416:Back Pain / Q000175:diagnosis / Q000601:surgery; D016025:Bone Transplantation / Q000009:adverse effects; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007738:Kyphosis / Q000175:diagnosis / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000175:diagnosis / Q000601:surgery*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology; D012008:Recurrence; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000175:diagnosis / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome