Autogenous Iliac Crest Bone Graft Research Articles

Clinical outcomes of treatment with cage-shaped demineralized bone plus local bone grafts vs. autogenous iliac crest bone grafts in instrumented single-level lumbar fusion: A retrospective cohort study.

The aim of the present study was to compare the clinical outcomes of cage-shaped demineralized bone plus local bone grafts (CDBLG) with those of autogenous iliac crest bone grafts (ICBG) implanted for the treatment of single-level lumbar intervertebral disc degenerative diseases. A total of 69 cases of degenerative spinal disorder treated between January 2011 and December 2013 were retrospectively analyzed. Of these, 44 were treated with CDBLG and 25 with autogenous ICBG. All fusions were instrumented single level. Fusion was assessed after 6, 12 and 24 months by X-ray and CT scans post-operatively. Clinical outcomes were determined during follow-up and assessments included the Oswestry Disability Index, Visual Analogue Scale for back and leg pain and the Short Form-36 general health survey physical component summary. The results indicated that the overall fusion rate at 24 months post-operatively was higher in the ICBG group compared with that in the CDBLG group, although not significantly (P>0.05). All other outcome measures were significantly improved in the two groups after the surgery (P<0.05), but no significant differences were observed between the two groups (P>0.05). Blood loss and mean duration of surgery in the CDBLG group were significantly lower compared with those in the ICBG group (P<0.05). In conclusion, CDBLG achieved a similar fusion rate and clinical outcome as ICBG but was associated with significantly reduced blood loss and mean duration of surgery. In conclusion, the present study provided CDBLG bone graft as an alternative option for single-level fusion.

Congenital pseudarthrosis of the tibia: the outcome of a pathology-oriented classification system and treatment protocol.

Congenital pseudarthrosis of the tibia is defined as a non-union of a tibial fracture that develops in a dysplastic bone segment of the tibial diaphysis. Pathologically, a fibrous hamartoma surrounds the bone at the congenital pseudarthrosis of the tibia site. The cases of 25 children, who have congenital pseudarthrosis of the tibia, were included in this study. Their ages ranged from 15 months to 15 years at the time of treatment. Neurofibromatosis-1 was present in 24 children. They were managed according to our classification system and treatment protocol. The treatment for mobile pseudarthrosis (types 1 and 2) included complete excision of the pathological periosteum, insertion of autogenous iliac crest bone graft, and combined fixation using intramedullary rod and Ilizarov external fixator. For type 3 pseudarthrosis (stiff pseudarthrosis), a pre-constructed Ilizarov fixator was applied for simultaneous distraction of the pseudarthrosis and deformity correction without open surgery. Evaluation of results was mainly radiological and included achievement of union, leg length equalization, deformity correction and prevention of refracture. Consolidation of the pseudarthrosis and osteotomies was achieved in all cases (100%). Refracture occurred in one case (4%) at the site of previous pseudarthrosis. Residual limb length discrepancy more than 2.5 cm occurred in two cases (8%). Valgus deformity of the ankle was present in 12 cases (48%) and was treated by supramalleolar osteotomy. Follow-up ranged from 24 to 48 months (average 36.9 months) after fixator removal. The results of our treatment protocol, based on our classification system, have been consistently good and predictable in all cases of congenital pseudarthrosis of the tibia. Mobility of the pseudarthrosis is an important factor in choosing the type of interference.

A prospective histomorphometric and cephalometric comparison of bovine bone substitute and autogenous bone grafting in Le Fort I osteotomies

PurposeThe aim of the present study was the histomorphometric and cephalometric comparison of autogenous bone grafting of the anterior iliac crest and the application of bovine bone substitute concerning new bone formation and postoperative stability in patients undergoing orthognathic Le Fort I osteotomy. Patients and methodsTwenty-five patients requiring orthognathic surgery with Le Fort I osteotomy were included in this study. Patients were randomly divided into three groups receiving either autogenous iliac crest BONE grafting (BONE; n = 8) or xenogenic bovine bone grafting (Bio-Oss®) in INTER (n = 12) or in ONLAY (n = 5) position. Histomorphometric analysis was performed using trephine bone biopsies from the autogenous, respectively xenogenic bone grafting region. Postoperative stability was evaluated using teleradiographies of three different timepoints. ResultsAll groups showed comparable mineralized fractions in bone biopsies of 50.2% (±13.2%) INTER, 46.48% (±12.3%) ONLAY and 57.1% (±20.6%) BONE as well as comparable percentage of connective tissue. Patients in the INTER-group revealed the lowest relapse rate of 20.5% (INTER) compared to 30.3% (ONLAY) and 33.0% (BONE). All groups underwent comparable maxillary advancement and healing time. ConclusionsPresent results indicate that block shaped bovine bone substitute is a promising alternative to autogenous bone grafting to bridge the Le Fort I osteotomy gap in orthognathic surgery.

Pedicled Vascularized Bone Graft Versus Induced Membrane Technique for Reconstruction of Forearm Medium-Size Bone Defects

There is no financial information to disclose. Induced membrane technique has proven satisfactory results for reconstruction of infected nonunion. However, more complex techniques such as vascularized bone grafts (VBG) are usually indicated in the presence of prior graft failure or a poor soft tissue bed. The purpose of this study is to compare the clinical and radiological outcomes of a series of patients treated for ulnar nonunion with medium-size bone defects. Patients were treated with either pedicled distal radius VBG (Figure 68-1) or induced membrane technique (IMT). Twelve patients who underwent surgery for reconstruction of infected forearm nonunion with bone defects up to 6 cm (minimum follow-up, 2 years) were selected retrospectively. Seven patients underwent distal radius pedicled VBG (group A) and 5 patients underwent reconstruction with the induced membrane technique (group B) (Figure 68-2). Mean follow-up was 34 months. The time between the original injury and the index procedure was 16 months (range, 11–20). The mean age was 42 years (range, 26–64). Patients were evaluated clinically and radiographically. The number of previous surgeries was recorded. Elbow and wrist range of motion, visual analog scale (VAS) for pain, the Quick-DASH questionnaire, and Mayo Elbow Perfomance Score (MEPS) were assessed. Complications and the need for reoperations were recorded. All nonunion were healed at final follow-up. The average defect size was 5.3 cm (range, 4.2–6). The average number of previous surgeries in the VBG group was 4.2 (range, 3–7) and in the IMT group was 2.8 (range, 2–5). The average time to union was 3.8 months (range 3–6) for group A, and 4.6 (range 4–6) for group B. Active ROM did not differ significantly between groups. Average QuickDASH was 13, and average MEPS was 83. At the 2-year follow-up, there were no significant differences in the VAS pain score (1.3 in group A; 0.9 in group B). There were 2 complications. In the VBG group, one patient required implant removal, and in the IMT group, 1 nonunion required autogenous iliac crest bone graft. Final results were satisfactory for both. No fracture or persistent donor site pain was observed in the VBG group. •In this limited series, both techniques showed favorable results and could be considered surgical alternatives for the treatment of infected ulnar nonunion.•Pedicled VBG showed a shorter time to union compared with induced membrane.Figure 68-2Intraoperative photographs of an ulnar defect reconstructed with a pedicled radius VBG (A) and with iliac crest bone graft, during the second stage of the induced membrane technique (B).View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Plate fixation with autogenous bone grafting for longstanding humeral shaft nonunion: A retrospective study of 6 cases.

Longstanding humeral shaft nonunion is uncommon because humeral shaft fractures often respond well to conservative and surgical treatments. However, when it occurs, the treatment of longstanding humeral shaft nonunion is challenging. This study is a retrospective analysis of the clinical and radiographic findings in a consecutive series of patients with longstanding humeral shaft nonunions who underwent locking compression plate (LCP) fixation and autogenous iliac crest bone grafting.Six patients were surgically treated at Xi’an Hong Hui Hospital for longstanding humeral shaft nonunions between February 2011 and June 2015. Four patients were of synovial pseudarthrosis, 1 was atrophic, and 1 was hypertrophic. Follow-up was for at least 12 months after intervention. Standardized treatment included a thorough debridement, LCP and screw fixation, and autogenous iliac crest bone grafting. In 3 patients, a single plate was applied, and in the other 3 patients, double plates were used. The main outcome measurements were shoulder and elbow function (Constant and Murley scale, and Mayo elbow performance index [MEPI]) and the visual analog scale (VAS) for pain. In addition, all complications were documented.Our series included 6 male patients with an average age of 56.3 years and an average nonunion duration of 19.5 years. All patients had previously undergone at least 1 operation. At a mean of 26 months follow-up, all fractures had achieved solid union and none of the implants had evidence of loosening or breakage. Postoperative alignment was within 10° of anatomic in 4 patients, 1 patient had 23° of valgus angulation, and 1 patient had a posterior angulation of 12°. Mean humeral shortening was 2.8 cm. The mean Constant and Murley joint function score was 88.3 points, the mean MEPI was 96.7 points, and the mean VAS was 0.7. All patients reported significant improvement in shoulder and elbow function, and each patient was able to resume work and was satisfied with the treatment.Plate fixation combined with autogenous iliac crest bone grafting is an excellent option for the treatment of longstanding humeral shaft nonunion.

Tissue Engineered Bone Differentiated From Human Adipose Derived Stem Cells Inhibit Posterolateral Fusion in an Athymic Rat Model.

Biological augmentation spinal arthrodesis trial in athymic rats. To assess the efficacy of tissue-engineered bone to promote L4-L5 intertransverse process fusion in an athymic rat model. Each year in the United States, over 400,000 spinal fusion surgeries are performed requiring bone graft. The current gold standard for posterolateral lumbar fusion is autogenous iliac crest bone graft (ICBG), but the harvesting of ICBG is associated with increased operative time and significant complications. This being the case, an alternative cost-effective bone graft source is needed. Bovine bone cores were sterilized and decellularized for scaffold production. Human adipose derived mesenchymal stem cells (ADSC) were obtained and verified by tridifferentiation testing and seeded onto dried scaffolds. The seeded cores were cultured for 5 weeks in culture medium designed to mimic endochondral ossification and produce hypertrophic chondrocytes. Single-level intertransverse process fusions were performed at the L4-L5 level of 31 athymic rats. Fifteen rats were implanted with the hypertrophic chondrocyte seeded scaffold and 16 had scaffold alone. Half of the study rats were sacrificed at 3 weeks and the other half at 6 weeks. Spinal fusion was assessed using 2D and 3D micro computed tomography (μCT) analysis and tissue histology. At 3 weeks, none of the tissue engineered rats had partial or complete fusion, whereas 62.5% of the decellularized rats fused and another 12.5% had partial fusions (P = 0.013). At 6 weeks, none of the tissue engineered rats fused and 50% had partial fusions, whereas 87.5% of the decellularized rats fused (P = 0.002). Tissue engineered bone composed of hypertrophic chondrocytes inhibits posterolateral fusion in an athymic rat model and therefore does not represent a promising cost-effective bone graft substitute. N/A.

A study of functional outcome of tibial condylar fractures treated with articular reconstruction

Objective: The goal of this study it to access the functional and radiological outcome of articular reconstruction as a treatment modality for depressed tibial condylar fractures, using autogenous iliac bone graft as a “filling agent” Material and Method: 36 patients involved in this study had post traumatic, closed tibial condylar fractures, Shatzker types II, III, V, VI (articular depression). All patients were maintained in skeletal traction until skin condition improved following which the patients underwent surgical intervention. Articular reconstruction was done by creation a cortical window, elevating the depressed articular fragment through the window and filling up the void with autogenous iliac crest bone graft. The reconstruction was stabilized with locking plates. Patients were started with static quadriceps exercise and controlled passive movements immediately post operatively. Weight bearing was delayed for 10- 12 weeks in all patients. Clinical and radiological assessment was done on each follow-up. Result: Out of the 36 patients, 28 patients had excellent and good results whereas 8 patients had poor results. Poor results were due to knee stiffness, short walking distance, incapacitating pain and decreased range of motion. 4 patients with poor results had anterior cruciate ligament laxity, reducing their clinical grading. Conclusion: Stable fixation with near normal articular reconstruction and striving to achieve a functional range of motion gives good results in depressed tibial condylar fractures in absence of infection and associated ligamentous injury.

Operative Treatment of 2-Part Surgical Neck Fracture of the Humerus: Intramedullary Nail Versus Locking Compression Plate With Technical Consideration

To compare the outcomes of patients who underwent either open reduction internal fixation with a locking plate and screws or closed reduction internal fixation with an antegrade intramedullary nail (IMN) for displaced surgical neck fracture of the humerus. Retrospective comparative study. Single institute, Level-I academic trauma center. Sixty-nine patients with 2-part surgical neck fracture of the humerus underwent either an IMN (38 patients group A) or a locked plate fixation (31 patients group B). Pain on a visual analog scale, University of California Los Angeles (UCLA) Shoulder Score, American Shoulder and Elbow Surgeons (ASES) score, and active range of motion (ROM). At the 2-year follow-up, there were no significant differences in the visual analog scale pain score (1.3 in group A; 0.9 in group B), ASES score (90.2 in group A; 91.9 in group B), and UCLA Shoulder Score (30.7 in group A; 31.8 in group B) between groups. Active ROM did not differ significantly between groups. There were 3 complications in the IMN group, 1 nonunion requiring autogenous iliac crest bone graft, and 2 cases of screw loosening. For displaced surgical neck fractures of the humerus, both IM nailing and locked plate fixation in patients yielded satisfactory outcomes at the 2-year follow-up with no significant differences in pain or ROM between groups. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Management of resistant distal femur non-unions with allograft strut and autografts combined with osteosynthesis in a series of 22 patients

Introduction and purposeChallenges to the surgeon in managing cases of resistant non-union of the distal femur include poor bone stock, disuse osteopenia and joint contractures. Procedures varying from simple bone grafting to megaprosthesis revision have been described. We successfully managed such cases using our technique of combining cortical allograft struts to augment the defect in the femoral condyle coupled with autogenous iliac crest bone grafting and locking plate osteosynthesis. Materials and methodsBetween April 2012 and May 2014, 22 patients who presented with resistant nonunions of the distal femur following initial surgery were managed using this technique. Cortical allograft struts were taken from the tissue bank of our institution. All patients were followed up post operatively and their time to union was noted. Functional outcome was calculated using LEFS (Lower extremity functional score). The average follow up of all our patients was 24 months. ResultsAll patients went on to achieve complete bony union. The average union time was 6.2 months (5 to 8 months). One patient who was a diabetic had superficial infection post operatively which was treated successfully with IV antibiotics. Average knee flexion was 110 degrees (80 to 130 degrees). The mean LEFS score was 72 (59 to 79). ConclusionCombing a locking plate fixation with the bone grafting technique of using an allograft strut to support the metaphyseal medial bone defect and autografts gives a good union and a good functional outcome in the management of resistant non-unions of the distal femur by enhancing the biology and providing a good structural support to the distal femur.

Titanium cages versus autogenous iliac crest bone grafts in anterior cervical discectomy and fusion treatment of patients with cervical degenerative diseases: a systematic review and meta-analysis

Objective: A systematic review and partial meta-analysis is conducted to compare the efficacy and safety of anterior cervical decompression and fusion procedures employing either rectangular titanium cages or iliac crest autografts in patients suffering from cervical degenerative disc diseases.Methods: Medline, PubMed, CENTRAL, and Google Scholar databases were searched up to June 2015, using the key words cervical discectomy; bone transplantation; titanium cages; and iliac crest autografts. Outcomes of interbody fusion rates were compared using odds ratios (ORs) with 95% confidence intervals (CIs). Values of the Japanese Orthopaedic Association score, and visual analog scale before and after operation were also compared.Results: The rate of interbody fusion was similar between patients in the iliac crest autograft and titanium cage groups (pooled OR = 0.33, 95% CI = 0.07 to 1.66, P = .178). The overall analysis showed that patients in the two groups did not have significantly different post-surgery Japanese Orthopaedic Association score (pooled difference in means = −0.05, 95% CI = 0.73 to 0.63, P = .876). Improvement in arm and neck pain scores were assessed with a visual analog scale and differed significantly between patients in the iliac crest autograft and titanium cage groups (pooled difference in means = 0.16, 95% CI = −0.44 to 0.76, P = .610; and pooled difference in means = −0.44, 95% CI = −2.23 to 1.36, P = .634, respectively).Conclusions: Our results suggest that the use of titanium cages constitutes a safe and efficient alternative to iliac crest bone autografts for anterior cervical discectomy with fusion.

Evaluation of Donor Site Morbidity Associated with Iliac Crest Bone Harvest in Oral and Maxillofacial, Reconstructive Surgery.

Iliac crest is the most common donor site for autogenous bone grafting as cortical bone, cancellous bone or combination of both can be harvested in abundance depending upon the need. Ilium provides highest concentration of osteo-component cells and greater quality of bone with less morbidity. The study was conducted to evaluate the donor site morbidity associated with autogenous iliac crest bone grafting for reconstruction in maxillofacial surgery. Around 12 patients, who had undergone iliac crest bone harvesting for various maxillofacial and reconstructive surgical procedures like cleft alveolus repair, malar augmentation, mandibular reconstruction following tumour resection and cyst enucleation and other surgical procedures performed in the Department of Oral and Maxillofacial Surgery, over a span of two years. The donor site was evaluated for the following factors: pain, neuropraxia, abnormal gait and scar evaluation. None of the 12 patients had intraoperative complications like haemorrhage, damage to the muscles/ligaments, fracture of the ilium and damage to the acetabular fossa/femur head. Any major postoperative complications were also not recorded. Minor postoperative complications like pain, contour defect, walking difficulty were present, which gradually got resolved by the time of discharge. Anterior iliac crest provides an adequate harvest of cancellous, corticocancellous or bicortical grafts for reconstruction of various osseous defects in the maxillofacial region with least morbidity and should be considered as a major reservoir of bone for bony reconstructive procedures.

Orthosis Free One Level Anterior Cervical Discectomy and Fusion Using Stand Alone Cage

Background Data: The anterior cervical discectomy and fusion (ACDF) operation has gained much popularity since its introduction in the 1950s by Smith and Robinson. Despite the biomechanical advantages of cage with or without plate application, the use of cervical collars or external cervical orthosis (ECO) after instrumented anterior cervical fusion is stillwidely practiced. Purpose: Our study aims at documenting the clinical and radiological outcomes of patients that had one level ACDF using standalone cage without the use of ECO in the postoperative period taking in consideration the results of other similar studies in the literature. Study Design: Retrospective cohort study on 50 patients that sufferedone-level cervical disc pathology in the form of degenerative spondylosis, radiculopathy or myelopathy. Outcome measures include visual analogue scale to compare the degree of neck and arm pain, Neck Disability Index, mean local segmental cervical angle, fusion, and mean disc height preoperative and six months and two years postoperative.Patients and Methods: Fifty patients had one level ACDF using standalone PEEK cage filled with autogenous iliac crest bone graft during the period between December 2009 and December 2013. Thirty one were females (62%) and nineteen were males (38 %). The indications for surgery were symptomatic single-level cervical spondylotic radiculopathy or myelopathy that had failed medical treatment for at least 6 weeks. Important exclusion criteria were traumaticinstability, severe osteoporosis, infection and tumors. Results: Fifty patients had one level ACDF with standalone cage, the correlation between both preoperative mean VAS for neck and arm pain and that after 6 months and 2 years postoperativereveals highly significant improvement with P-value 0.0001. In the meantime, concerning neck disability index (NDI) the correlation between preoperative mean and that at 6 months and 2 years postoperative showed significant improvement with P-value 0.0001. Conclusion: In comparison to the results in the literature demonstrating the outcomes of both ACDFwith the usage of ECO and without in the postoperative period, our results show that the use of a cervical brace does not improve the fusion rate or the clinical outcomes of patients undergoing singlelevel ACDF using standalone PEEK cage filled with autogenous iliac crest bone graft. (2016ESJ106)

Bone Graft Substitution and Augmentation.

Selection of appropriate bone graft or bone graft substitute requires careful recognition of the bone healing needs of the patient's specific clinical problem and a thorough understanding of the different properties possessed by the available bone grafts and substitutes. Although autogenous iliac crest bone graft remains the gold standard of treatment for delayed unions, nonunions, and bone defects, there are a number of promising alternatives available, and emerging evidence suggests that they can be very effective when used in the proper setting. Among these, reamer-irrigator-aspirator bone graft, bone marrow concentrate, bone morphogenetic proteins, and calcium phosphate cements have received a great deal of attention in the literature. This review describes these grafts in detail along with the evidence for their use. In addition, a framework is provided for selecting the appropriate graft or substitute based on their provided properties.

Type of bone graft or substitute does not affect outcome of spine fusion with instrumentation for adolescent idiopathic scoliosis.

Retrospective cohort analysis. To compare clinical outcomes after spine instrumentation and fusion using 3 different bone grafts in children with adolescent idiopathic scoliosis (AIS). Autogenous iliac crest bone graft (AIC) is the "gold standard" to promote fusion in posterior AIS operations, although the morbidity of harvest is a concern. There is limited data comparing outcomes after AIS surgery based on types of bone grafts. Children (10-18 yr) with AIS who underwent deformity correction via a posterior approach were identified in the Spinal Deformity Study Group database. All had a minimum of 2-year follow-up. Patients were subdivided into 3 groups based on bone graft used: AIC, allograft, and bone substitute (BS). Clinical data included patient demographics, operative details, postoperative analgesic use, and perioperative complications. Lenke curve type and curve magnitude changes were radiographically analyzed. The Scoliosis Research Society-30 questionnaire was used to assess clinical outcomes. 461 patients met inclusion criteria (girls: 381, boys: 80; average age 14.7 ± 1.7) and consisted of 152 AIC patients (124 girls, 28 boys), 199 allograft patients (167 girls, 32 boys), and 110 BS patients (90 girls, 20 boys). There was no difference in age (P = 0.41) or gender (P = 0.82). The BS group had significantly smaller preoperative curves and shorter operative times. Postoperatively, patients who received BS had significantly longer hospital stays, used higher quantities of patient-controlled intravenous analgesia and used epidurals longer. The AIC group used patient-controlled intravenous analgesia significantly longer. There were no differences between the groups in regards to curve type, number of levels fused, postoperative infections, pseudarthrosis, reoperations for any indication, and Scoliosis Research Society-30 scores at the latest follow-up. Outcomes after primary posterior spinal fusion with instrumentation are not influenced by type of bone graft or substitute. 3.

Outcomes of arthroscopic treatment of osteochondritis dissecans of the capitellum and description of the technique

We hypothesize that a technique for all-arthroscopic fixation of capitellum osteochondritis dissecans (OCD) lesions using suture fixation and autogenous iliac crest bone grafting offers a successful alternative to open internal fixation techniques as shown by 2-year validated patient-reported outcomes. Our technique uses arthroscopic all-inside suture fixation with iliac crest autogenous bone grafting. The procedure was performed on 4 elite-level, adolescent athletes presenting with 5 unstable capitellum OCD lesions resulting in elbow pain, limited range of motion, and decreased ability to play. Magnetic resonance imaging showed an unstable OCD lesion, which was correlated with arthroscopy. Postoperatively, patients were evaluated by the short version of the Disabilities of the Arm, Shoulder and Hand questionnaire; Oxford Elbow and Mayo Elbow scores; visual analog scale; postoperative range of motion; and return to play. Three female patients and one male patient aged 13 to 15years underwent the procedure. The mean final follow-up period was 2.8years. Union was achieved in all patients, as seen on magnetic resonance imaging at a mean of 3 months. At follow-up, the mean loss of extension was 2°. Mean flexion was 153°. There was no loss of supination or pronation. The mean score on the short version of the Disabilities of the Arm, Shoulder and Hand questionnaire was 11. The mean Mayo Elbow score was 88. The mean Oxford Elbow score was 42. The mean visual analog scale score was 2. The mean time to return to play was 4months. All patients continued to compete at an elite level. There were no infections or cases of fixation failure, and no patients required conversion to open surgery or needed revision surgery. Arthroscopic all-inside fixation of unstable OCD lesions is a successful technique, facilitating athletes to return to an elite level of play.

Efficacy of Postoperative Pain Management Using Continuous Local Anesthetic Infusion at the Iliac Crest Bone Graft Site in Patients with Adolescent Idiopathic Scoliosis: A Parallel, Double-Blinded, Randomized Controlled Pilot Trial.

Study Design Randomized controlled trial. Objective Adolescent idiopathic scoliosis (AIS) is a common spinal deformity that affects every population. In severe deformity, surgical intervention is performed. Autogenous iliac crest bone graft (ICBG) harvesting remains a common procedure worldwide for scoliosis surgery. Postoperative pain at the ICBG donor site is a major concern in patients undergoing spine surgery that affects postoperative functional outcome and consumes health care resources. Previous studies have noted a decrease in pain and postoperative analgesic use with the application of continuous infusion of anesthetic at the ICBG site in comparison with placebo. However, there is lack of evidence addressing the efficacy of continuous anesthetic infusion at the ICBG site in young patients and in particular those with spinal deformity, such as AIS. As such, this parallel, double-blinded, randomized controlled trial addressed the pain management efficacy of continuous anesthetic infusion versus saline at the ICBG site in patients with AIS during the immediate postoperative period. Methods Participants were randomized into two groups. Group A (control subjects) received 3 mL per hour of saline locally at the ICBG site, and group B (treatment subjects) received a constant rate of infusion of 3 mL per hour of 0.25% levobupivacaine. Both groups received their postoperative intervention for 47 hours. All subjects and outcome assessors were blinded to the type of intervention. Utilizing the visual analog pain scale, pain was assessed at the primary spine surgical site, ICBG site, and contralateral ICBG site. Overall physical pain was assessed by the McGill Pain Questionnaire. The degree of analgesic use and complications were also evaluated. All outcomes were assessed up until the fourth day of the patients' hospitalization following surgery. Results Twelve subjects were recruited (five in group A; seven in group B). No difference was noted at baseline regarding age, weight, height, arm span, sex, curve type, instrumented and fused levels, length of hospitalization, and pain scores between groups. Postoperatively, no difference was noted in surgical site pain between groups (p > 0.05). However, decreased ICBG and contralateral ICBG pain decreased twofold in group B patients in comparison with group A. Similarly, group B subjects had notably decreased postoperative overall pain scores (group A, mean 15.3; group B, mean 3.8). No significant differences were noted for the pain scores due to the small sample size. Conclusions This study is the first with a robust level I study design to assess the efficacy of continuous infusion of analgesia into the ICBG site in young patients with AIS. This pilot study noted a trend that continuous anesthetic infusion reduces pain at the ICBG site and may further decrease overall physical bodily pain. This study further established a sample size calculation to facilitate large-scale studies addressing these parameters. This study provides further support of postoperative pain management options for children with spinal deformities.

Femoral head-neck junction reconstruction, after iatrogenic bone resection.

Arthroscopic over-resection of the head-neck junction during the treatment of a cam deformity can be a devastating complication and is difficult to treat. Large defects of the femoral head-neck junction (FHNJ) increase the risk of femoral neck fracture and can also affect hip biomechanics. We describe a case of an iatrogenic defect of the FHNJ due to excessive bone resection, and a previously non-described treatment using iliac crest autograft to restore femoral head-neck sphericity and hip joint stability. After protecting the femoral neck with an angled blade plate, the large anterior FHNJ defect was reconstructed using autogenous iliac crest bone graft; sphericity was restored by contouring the graft using spherical templates. Clinical and radiographic follow-up was performed up to 2 years. Results at 2 years showed no residual groin pain and normal range of motion. The Oxford Hip Score was 46/48, rated as excellent. Computed tomography (CT) scanning showed union of bone graft without resorption, and CT arthrogram indicating retained sphericity of the FHNJ without evidence of degenerative changes in the articular surface. This novel surgical technique can be used to restore the structural integrity and contour of the FHNJ that contains a significant anterior defect.

The effect of aging on posterior intertransverse lumbar fusion: a New Zealand white rabbit model.

In vivo assessment of lumbar spinal fusion between a younger and older cohort of New Zealand white rabbits. Directly compare fusion within young and aged New Zealand white rabbits to establish an aged spinal fusion model translational research. Prior studies have utilized skeletally mature young rabbits (6-12 mo old) that may not be appropriate as an analog for studying the aging human spine. Ten aged (>36 mo old) and 10 young (12 mo old) New Zealand white rabbits underwent a single-level, bilateral, L5-6 posterolateral intertransverse fusion using autogenous iliac crest bone graft. The animals were killed at 6 weeks postoperatively, and the specimens were then evaluated with quantitative microcomputerized tomography and manual palpation by 6 orthopedic surgeons. The fusions were graded as either fused or not fused by each examiner. The spines were then embedded in poly(methyl methacrylate) and cut into 2-mm-thick sections for histologic analysis. A higher percentage of young rabbits were determined to be successfully fused through manual palpation testing compared with the aged rabbits. Micro-computed tomography (CT) analysis revealed a significantly greater fusion mass volume in the younger rabbits than in the older cohort. In addition, the fusion density of the younger rabbits was found to be significantly lower than that of the older rabbits when normalized to the bone density in the nonfused portion of the spine. Histologic analysis showed that the quality of the bone within the fusion mass was consistent between the young and old rabbits. A greater number of young animals had bilateral continuous bone graft compared with the aged animals. The aged (>36 mo) New Zealand white rabbit model appears to be a valid model to evaluate the effect of aging on lumbar fusion and has the potential to more accurately model conditions that are present in the older human spine.

Reconstruction of orbital floor blow-out fractures with autogenous iliac crest bone: A retrospective study including maxillofacial and ophthalmology perspectives

This is a 10-year retrospective study of patients with an isolated unilateral orbital floor fracture reconstructed with an autogenous iliac crest bone graft. The following inclusion criteria applied: isolated orbital floor fracture without involvement of the orbital rim or other craniofacial injuries, pre-/post-operative ophthalmological/orthoptic follow-up, pre-operative CT. Variables recorded were patient age and gender, aetiology of injury, time to surgery, follow-up period, surgical morbidity, diplopia pre- and post-operatively (Hess test), eyelid position, visual acuity, and the presence of en-/or exophthalmos (Hertel exophthalmometer). Twenty patients met the inclusion criteria. The mean age was 29 years. The mean follow up period was 26 months. No patient experienced significant donor site morbidity. There were no episodes of post-operative infection or graft extrusion. Three patients had diplopia in extremes of vision post-operatively, but no interference with activities of daily living. One patient had post-operative enophthalmos. Isolated orbital blow-out fractures may be safely and predictably reconstructed using autogenous iliac crest bone. The rate of complications in the group of patients studied was low. The value of pre- and post-operative ophthalmology consultation cannot be underestimated, and should be considered the standard of care in all patients with orbitozygomatic fractures, in particular those with blow-out fractures.

A Prospective Trial Comparing L4/5 Instrumented Posterolateral Fusion for Degenerative Spondylolisthesis Performed with Local Bone Graft Alone versus Posterior Iliac Crest Graft and Local Bone Graft versus Beta Tricalcium Phosphate and Local Bone Graft

Introduction Prospective randomized radiological comparative study on the status of fusion in single level instrumented posterolateral lumbar fusion in low-grade spondylolisthesis using local bone graft versus iliac crest bone graft and local bone versus β-tricalcium phosphate and local bone graft. Materials and Methods A total of 24 patients in three groups with degenerative low-grade spondylolisthesis with stenosis randomly underwent decompressive laminectomy and single level instrumented posterolateral fusion with either local bone only or iliac crest bone graft with local bone or β-tricalcium phosphate and local bone graft. Each group consisted of eight patients and was followed for a minimum of 2 years after which a CT scan was done to evaluate the fusion mass according to the Lenke et al classification system. Results At the end of 2 years, no pseudoarthrosis was observed in either of the three groups. In the local bone graft only group, four (50%) patients had a definite solid fusion mass while the remaining four (50%) had a probable solid fusion mass. In the iliac crest group, seven (87.5%) had a definite fusion mass while one patient had a probable fusion mass. In the β-tricalcium phosphate group, five (62.5%) patients had a definite fusion while three (37.5%) had a probable solid fusion mass. Although iliac crest graft remains as the gold standard, its associated donor site morbidity has limited its use. Hence, local bone graft or substitutes such as β-tricalcium phosphate are frequently used. However, there seems to be no significant advantage of β-tricalcium phosphate over iliac crest graft in terms of the fusion status. Conclusion Although iliac crest bone graft remains the gold standard in lumbar fusion procedures, its associated morbidity limit its usage. Hence, local bone alone or combined with β-tricalcium phosphate are frequently used. However, there is no significant advantage of β-tricalcium phosphate over the local bone graft or iliac crest graft in terms of the fusion status. Disclosure of Interest None declared References Sengupta DK, Truumees E, Patel CK, et al. Outcome of local bone versus autogenous iliac crest bone graft in the instrumented posterolateral fusion of the lumbar spine. Spine 2006;31(9):985–991 Herzog RJ, Marcotte PJ. Assessment of spinal fusion. Critical evaluation of imaging techniques. Spine 1996;21(9):1114–1118 Larsen JM, Rimoldi RL, Capen DA, Nelson RW, Nagelberg S, Thomas JC Jr. Assessment of pseudarthrosis in pedicle screw fusion: a prospective study comparing plain radiographs, flexion/extension radiographs, CT scanning, and bone scintigraphy with operative findings. J Spinal Disord 1996;9(2):117–120 Zdeblick TA. A prospective, randomized study of lumbar fusion. Preliminary results. Spine 1993;18(8):983–991 Lenke LG, Bridwell KH, Bullis D, Betz RR, Baldus C, Schoenecker PL. Results of in situ fusion for isthmic spondylolisthesis. J Spinal Disord 1992;5(4):433–442 Dimar JR II, Glassman SD, Burkus JK, Pryor PW, Hardacker JW, Carreon LY. Two-year fusion and clinical outcomes in 224 patients treated with a single-level instrumented posterolateral fusion with iliac crest bone graft. Spine J 2009;9(11):880–885 Dai LY, Jiang LS. Single-level instrumented posterolateral fusion of lumbar spine with beta-tricalcium phosphate versus autograft: a prospective, randomized study with 3-year follow-up. Spine 2008;33(12):1299–1304