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Title: Bone graft in posterior spine fusion for adolescent idiopathic scoliosis: a meta-analysis.
Austin Authors: Kirzner, Nathan;Hilliard, Luke;Martin, Catherine;Quan, Gerald M Y ;Liew, Susan;Humadi, Ali
Affiliation: Orthopaedic Department, Alfred Hospital, Melbourne, Victoria, Australia
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
Department of Spinal Surgery, Austin Health, Heidelberg, Victoria, Australia
Department of Orthopaedic Surgery, Austin Health, Heidelberg, Victoria, Australia
Issue Date: 15-May-2018 2018-05-15
Publication information: ANZ Journal of Surgery 2018; 88(12): 1247-1252
Abstract: The aim of this study was to systematically analyse and perform a meta-analysis on the current available literature comparing the fusion rates and complications associated with use of autograft, allograft and bone substitutes to supplement posterior spinal fusion for adolescent idiopathic scoliosis (AIS). The electronic databases including Embase, PubMed, Medline, Cinahl and Cochrane Library were searched to identify relevant studies. A total of 12 studies with 2389 patients were included for meta-analysis. The primary outcome was fusion rate, while the secondary outcomes included blood loss, operation time, infection rates and post-operative pain. The current meta-analysis found no difference in fusion rates between groups with an overall fusion rate of 100% (95% confidence interval (CI) 0.99-1.00; P < 0.05). Total estimated blood loss was significantly higher in the iliac crest bone graft (ICBG) group compared with control group (1018 versus 861 mL; P < 0.01). In addition, the mean operative time was significantly higher in the ICBG group (259 versus 237 min; P < 0.001). The ICBG group also had increased post-operative pain issues compared with the control group (26 versus 9%; P < 0.001). There was no significant difference in terms of post-operative wound infection between groups with an overall infection rate of 1% (95% CI 0.0-0.02; P = 0.06). ICBG confers no advantage over the other graft options in achieving fusion in AIS surgery. Furthermore, crest harvesting was associated with significant increases in blood loss, operative time and post-operative pain issues. Therefore, allograft and bone substitutes are attractive alternatives to autogenous grafting during posterior fusion in AIS.
DOI: 10.1111/ans.14551
ORCID: 0000-0002-6043-0710
PubMed URL: 29763982
Type: Journal Article
Subjects: adolescent idiopathic scoliosis
bone graft
posterior fusion
spine surgery
Appears in Collections:Journal articles

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