title: Comparison between harvesting and preserving the spinous process for adolescent idiopathic scoliosis.
abstract: Spinous process has been routinely resected during posterior fusion of adolescent idiopathic scoliosis for fusion bed preparation and local autologous bone graft supplement. However, spinous process serves as an important structure in posterior ligament complex and was the anchorage of paraspinal muscle groups. With the development of pedicle screws instrumentation and the potential fusion ability in children, the need for resecting spinous process in this procedure could be further investigated. The purpose of this study was to compare the fusion rates, surgical outcomes and complications between harvesting and preserving the spinous process in posterior fusion of adolescent idiopathic scoliosis.
  
  
  
  From January 2003 to December 2008, 104 consecutive adolescent idiopathic scoliosis patients underwent primary posterior fusion with local autologous bone grafts and following for a minimum of 24 months were reviewed. The patients were divided into a harvesting group (n = 61) with the spinous process harvested, and a preserving group (n = 43) with the spinous process preserved. Blood loss, radiographic assessments, and clinical outcomes were compared between the two groups.
  
  
  
  There were no significant differences in duration of surgery and peri-operative blood transfusion between the two groups. However, blood loss was statistically greater (983 ± 446 ml vs. 824 ± 361 ml; p = 0.048) and duration of hospitalization was statistically longer (7.4 ± 1.0 days vs. 6.8 ± 0.8 days; p = 0.003) in the harvesting group. The pre- and post-operative structural curves, correction rates, sagittal profile and loss of corrections were similar in both groups. Based on radiographic evaluation, the incidences of pseudoarthrosis were similar in both groups (3/61 vs. 2/43; p = 0.95). The incidence of prescribing pain medication for back discomfort during follow-up was statistically higher in the harvesting group (16/61 vs. 4/43; p = 0.03).
  
  
  
  The surgical outcomes and fusion rates between harvesting and preserving the spinous process were comparable. Resecting the spinous process as local autologous bone graft may not be necessary in posterior fusion for adolescent idiopathic scoliosis patients.
authors: Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 33305, Taiwan.|Bone and Joint Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
authors: Yu-Cheng
authors: YC
authors: Yeh
authors: Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 33305, Taiwan.|Bone and Joint Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors: Chi-Chien
authors: CC
authors: Niu
authors: Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 33305, Taiwan.|Bone and Joint Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors: Lih-Huei
authors: LH
authors: Chen
authors: Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 33305, Taiwan.|Bone and Joint Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors: Wen-Jer
authors: WJ
authors: Chen
authors: Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 33305, Taiwan. polianglai@gmail.com.|Bone and Joint Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan. polianglai@gmail.com.|College of Medicine, Chang Gung University, Taoyuan, Taiwan. polianglai@gmail.com.
authors: Po-Liang
authors: 0000-0002-2020-919X
authors: PL
authors: Lai
mesh_terms: D000293:Adolescent; D000328:Adult; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D016025:Bone Transplantation / Q000009:adverse effects*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D061646:Operative Time; D065289:Pedicle Screws; D011542:Pseudarthrosis / Q000453:epidemiology* / Q000209:etiology; D011859:Radiography; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D013904:Thoracic Vertebrae / Q000601:surgery*; D014182:Transplantation, Autologous / Q000009:adverse effects; D016896:Treatment Outcome; D055815:Young Adult
keywords: Adolescent idiopathic scoliosis; Local autologous bone graft; Pedicle screw instrumentations; Posterior fusion; Pseudoarthrosis; Spinous process