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


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.


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


METHODS
Level IV.
Klinikum der Albert-Ludwigs-Universität Freiburg, Department Orthopädie und Traumatologie, 79106 Freiburg im Breisgau, Germany. Electronic address: david-christopher.kubosch@uniklinik-freiburg.de.
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Kubosch
Klinikum der Albert-Ludwigs-Universität Freiburg, Department Orthopädie und Traumatologie, 79106 Freiburg im Breisgau, Germany.
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Konstantinidis
Klinikum der Albert-Ludwigs-Universität Freiburg, Department Orthopädie und Traumatologie, 79106 Freiburg im Breisgau, Germany.
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Helwig
Klinikum der Albert-Ludwigs-Universität Freiburg, Department Orthopädie und Traumatologie, 79106 Freiburg im Breisgau, Germany.
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Hirschmüller
Klinikum der Albert-Ludwigs-Universität Freiburg, Department Orthopädie und Traumatologie, 79106 Freiburg im Breisgau, Germany.
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Strohm
Klinikum der Albert-Ludwigs-Universität Freiburg, Department Orthopädie und Traumatologie, 79106 Freiburg im Breisgau, Germany.
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Südkamp
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016348:Osseointegration; D012086:Reoperation; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014182:Transplantation, Autologous; D055815:Young Adult
Bone graft; Correction loss; Spinal fusion; Spondylodesis