Corrélation entre ostéo-intégration de la greffe osseuse autologue et perte de correction après arthrodèse antéropostérieure des fractures traumatiques du corps vertébral

Abstract

BackgroundA 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. Materials and methodsRetrospective 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. ResultsThe following mean angle changes were derived from the second series of CT-scans performed on average 283days 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%, kaudal 17%; graft-resorption: 7%. No correlation was found between the above-mentioned angle changes and fusions grade. DiscussionThe importance of radiological evidence of fusion deficiency is questionable, because the extent of fusion only has a minimal effect on correction loss. Level of evidenceLevel IV.