Preservation Technique of Autologous Bone in Scoliosis Surgery

Abstract

Study Design This is a retrospective study. Objective This study aims to describe surgical technique of locally wound autologous bone conservation when primary surgery becomes mandatory to be staged, described as well the evolution and technique complications. Introduction One of the goals of scoliosis surgery is to halt the progression of curves achieving solid fusion. The contribution of additional bone graft in particular cases is critical. There are different types of bone grafts or bone substitutes, with different costs, and technical complications; it has become increasingly important the way to obtain and preserve a good amount of autologous bone. Patients and Methods A total of 12 patients, who required two-staged surgical procedures, were operated from June 2012 to April 2014 in our Spine Department. A subfascial pocket was performed in paraspinal muscles at the distal end of the surgical field where we added 1 g of vancomycin every 50 mL of bone graft. Surgical procedure, surgical correction, and complications with a full detailed analysis of infectious complications were assessed and recorded. Results Overall, 12 patients were operated in our hospital Spine Department with a two-staged surgical procedure plan. Patients mean age at surgery was 14 years. The etiology of deformity consisted in five idiopathic scoliosis, three congenital scoliosis, one associated with high-grade spondylolisthesis, two neuropathic scoliosis, and one myopathic scoliosis. In five cases (41.6%), surgery was initially staged in two different surgical days according to surgeon criteria and spinal severity deformity, in the other seven cases (58.4 degrees), the surgeon in charge, resolved to reschedule the surgical procedure in two different stages because of some intraoperative urgent event. The mean preoperative scoliosis angular value was 92.8 degrees. The mean postoperative scoliosis angular value was 42.4 degrees. We found that every patient in this study group required three surgical procedures to solved spinal deformity. Five patients developed superficial or deep infection (41.6%). Conclusion The local conservation of autologous bone graft in severe scoliosis surgery that has to be rescheduled or was already staged in 2 different days can be performed by storing the local bone graft in a subaponeurotic or subfascial pocket, with proper bone fusion imaging recordings, without incurring in an increasing risk of infection diminishing health costs.