Autogenous Iliac Crest Graft Research Articles

Fixed-angle plate fixation and autogenous iliac crest graft for repair of distal metaphyseal femoral nonunion.

To analyze clinical, radiographic and patient-reported outcomes of distal metaphyseal femoral nonunions treated with fixed-angle plates and screws. All patients presenting with a distal metaphyseal femoral fracture nonunion repaired with fixed-angle plating from one urban level 1 trauma center and an orthopedic specialty hospital were identified. Baseline demographic, injury information, and outcomes (healing rates, Short Musculoskeletal Function Assessment, range of motion, and post-operative pain levels) at 12months following nonunion repair were collected. Outcomes were evaluated between patients fixed with a blade plate and with a locking plate. Of these 31 patients, 27 (87.1%) healed after their index nonunion surgery, 2 (6.5%) healed after one reoperation, 1 (3.2%) healed after 2 reoperations, and 1 (3.2%) had a persistent nonunion but did not want further treatment. At one-year follow-up, the group demonstrated a significant improvement in functional recovery with a mean difference of 14.5 points (p = 0.007) when compared to status before fixed-angle fixation of the nonunion. There was also a significant change in patient-reported pain levels using the VAS scale with a mean difference of 2.0 points (p = 0.009). At one-year follow-up, 11 (39.3%) had full knee range of motion (0-130), 11 (39.3%) had flexion greater than 90 and less than 120°, and 6 (21.4%) had range of motion less than 90°. Patients who undergo fixed angle plating and autogenous bone grafting for distal femoral metapyseal nonunionsdemonstrate improved functional outcomes and VAS pain score at one year follow up.

SURGICAL TREATMENT OF EXTENDED JUVENILE OSSIFYING FIBROMA IN A PEDIATRIC PATIENT: A CASE REPORT

A 2-year-old male patient presented to a dental clinic with painless swelling on the right side of the face in the zygomatic-orbital region with approximately 2 months of evolution. Computed tomography scan revealed an extensive, solid, expansive lesion inside the right maxillary sinus invading the right maxillary alveolar ridge and ipsilateral nasal cavity, causing elevation of the orbital floor. Incisional biopsy, complementary blood tests, and clinical aspects suggested a diagnosis of central giant cell lesion. The patient underwent surgery for enucleation and curettage of the lesion under general anesthesia. The orbital floor, infraorbital margin, and part of the maxillary alveolar ridge were reconstructed with an autogenous iliac crest graft, and gaps were filled with xenograft. The maxillary sinus antrum was preserved by placing a fibrin sponge inside it. The histopathologic material was sent for analysis and then reviewed, establishing a final diagnosis of trabecular juvenile ossifying fibroma. Postoperative recovery was without complications, with no signs of recurrence.

Repair of symptomatic bilateral L5 spondylolysis with autogenous iliac crest graft and temporary intersegmental pedicle screw fixation in youth

BackgroundWhen symptomatic spondylolysis fail to respond to nonoperative treatment, surgical management may be required. A number of techniques have been described for repair by intrasegmental fixation with good results; however, there are still some problems. We reported a repair technique with temporary intersegmental pedicle screw fixation and autogenous iliac crest graft. The aim of present study is to assess the clinical outcomes of L5 symptomatic spondylolysis with this technique.MethodsA retrospective analysis of 128 patients with L5 spondylolysis treated with this method was performed. According to CT scan, the spondylolysis were classified into 3 categories: line, intermediate, and sclerosis type. The diagnostic block test of L5 bilateral pars defect was done in all patients preoperatively. The sagittal and axial CT images were used to determine the bone union. The healing time, complications, number of spina bifida occulta, Japanese Orthopedic Association (JOA) score, and VAS for back pain were recorded. After fixation removal, the rate of ROM preservation at L5S1 was calculated.ResultsThere were 97 patients (194 pars) followed with mean follow-up of 23 months (range, 12–36 months). The union rate of pars was 82.0% at 12 months and 94.3% at 24 months postoperatively. Low back pain VAS significantly (P < 0.05) improved from preoperative mean value of 7.2 to 1.3 at the final follow-up postoperatively (P < 0.05). JOA score increased significantly postoperatively (P < 0.05) with average improvement rate of 79.3%. The rates of L5S1 ROM preservation were 79.8% and 64.0% after fixation removal at 1 and 2 years postoperatively. There were 3 patients of delayed incision healing without other complications.ConclusionsAlthough sacrificing L5S1 segment motion temporarily, more stability was obtained with intersegmental fixation. This technique is reliable for spondylolysis repair which has satisfactory symptom relief, high healing rate, low incidence of complications, and preserve a large part of ROM for fixed segment.

Congenital Kyphosis: Progressive Correction With an Instrumented Posterior Epiphysiodesis: A Preliminary Report.

Congenital kyphosis is a rare condition. In this case series we sought to identify the outcomes and complications of posterior instrumented fusion and the resultant epiphysiodesis effect in uniplanar congenital kyphosis in pediatric patients. Pediatric patients were included if treated for a uniplanar congenital kyphotic deformity treated with posterior instrumented spinal fusion between October 2006 and August 2017, with a minimum of 2 years of follow-up. Patients were excluded if a coronal deformity >10 degrees was present. Six patients met the inclusion criteria. Mean age at surgery was 3.6 years. The mean kyphotic deformity before surgery was 49.7 degrees. All patients underwent posterior instrumented fusion with autogenous iliac crest graft and a cast or brace postoperatively. One patient showed a loss of motor evoked potential on prone positioning which returned to normal on supine positioning. No patient showed any postoperative neurological deficits. One patient was diagnosed with a wound infection which was successfully treated with oral antibiotics.By a follow-up of 5.4 years (range, 2.2 to 10.9 y) there was no failure of instrumentation. An epiphysiodesis effect (a difference of ≥5 degrees in the kyphotic deformity measured between the immediate postoperative and final follow-up lateral whole spine XR) of 16.2 degrees (range, 7.2 to 30.9 degrees) was seen in 5 patients. The mean annual epiphysiodesis effect was 2.7 degrees (95% confidence interval, 1.4-4.1 degrees). No kyphosis proximal to the instrumentation was observed for the duration of follow-up. Posterior instrumented fusion and epiphysiodesis is safe and effective. The epiphysiodesis effect occurs in 5/6 of cases, and our data suggests that the procedure is associated with an acceptable blood loss and a low incidence of neurological complications.

MANDIBULAR CHONDROMYXOID FIBROMA: A CASE REPORT

The chondromyxoid fibroma comprises a rare benign cartilaginous neoplasm with a preference for long bones, especially fibula, in which only 2% of cases can arise in the craniofacial bones. We report a case of a 27-year-old leucoderm female patient without systemic comorbidities was referred to the oral surgery service after radiographic findings. The clinical examination showed expansion of the lingual mucosa on the right, without clinical symptoms and absence of dental mobility. At the radiographic examination, the patient had an extensive circumscribed radiolucent lesion, with a sclerotic margin, lingual and basilar cortical expansion, and preservation of the vestibular cortical bone. The diagnostic hypothesis was ameloblastoma. The incisional biopsy was performed, and after negative needle puncture cystic lesion was discarded. The histopathologic diagnosis was of chondromyxoid fibroma. The treatment was resection of the lesion with bone reconstruction using autogenous iliac crest graft in the first surgical time, with load-bearing–type fixation.

Combined medial malleoplasty and Taylor Spatial Frame after a supramalleolar osteotomy in the treatment of ankle deformity in skeletally immature patients: A prospective study of a novel technique and the short-term results

Background: This study examined the effectiveness of the Taylor Spatial Frame (TSF) in the treatment of deformity and limb shortening caused by distal tibial physeal arrest and the effectiveness in maintaining alignment and stability by reconstruction of the medial malleolus and the medial collateral ligament using an autogenous iliac crest graft and attached sartorius muscle-tendon. Methods: Thirteen pediatric patients with angular deformity of the distal tibia were enrolled in this prospective study. The mean age was 8.3 yr (range, 6 to 12 yr). All patients had open fractures with skin loss. Ten patients had Salter-Harris type IV physeal fractures, while three had Salter-Harris type V physeal injury. All patients had a varus ankle deformity (range, 15 to 33 degrees) and limb shortening (range, 1.9-cm to 3.3-cm). All patients were treated by a supramalleolar osteotomy and TSF for deformity correction for limb-length equalization. The absent medial malleolus was treated by medial malleoplasty with a graft from the ipsilateral iliac crest. Results: The mean follow-up period was 30 mo. The mean preoperative shortening of the tibia in relation to the fibula was 2.6 cm (range, 1.9 cm to 3.3 cm). The length of the short tibia was restored in all patients, and correction of the ankle deformity and stability were restored with a satisfactory outcome. Conclusions: TSF is highly effective in the treatment of distal tibial deformity in pediatric patients due to traumatic physeal arrest. Reconstruction of the medial malleolus and its ligamentous attachment is crucial for ankle joint stability. Level of Evidence: Level IV.

Knee Arthrodesis Using Ilizarov Method with Autogenous Bone Graft Application in a Second-Stage Surgery: A Case Report of a Morbidly Obese and Diabetic Patient with a Septic Failure of Total Knee Arthroplasty

Currently, the main indication for knee arthrodesis is septic failure of a total knee arthroplasty (TKA). Circular external fixation has shown good results, and it is a good option to treat these cases. We present a case of a morbidly obese female, 55 years old, with a chronic septic failure of TKA, submitted to a knee arthrodesis using the Ilizarov technique. In a second-stage surgery, the remaining bone defect was filled with autogenous iliac crest graft. A radiographic and clinical fusion was verified 3 and 5 months, respectively, after the primary surgery. Twelve months later, she is very satisfied with the surgery results, presenting a Visual Analog Scale score 1 and a stable and pain-free lower limb. The residual limb length discrepancy was 3 cm, and she walks with a shoe lift without external support. Our case emphasizes the importance of autogenous bone graft application in a second-stage surgery to a successful and fast knee arthrodesis using the Ilizarov method in patients with chronic septic failure of TKA and severe comorbidities.

Analysis of the Survival of Dental Implants Installed in Reconstructed Maxilla With Autogenous Iliac Crest Graft: 7- to 9-Year Follow-Up.

The aim of this study was to analyze the survival of dental implants installed in maxillae reconstructed with autogenous iliac crest grafts and to assess patient satisfaction with the treatment by means of a questionnaire. The study conducted medical record reviews and clinical/radiographic assessments of 10 patients with severe maxillary atrophy who had undergone reconstruction with autogenous iliac crest grafts and rehabilitation with dental implants between 2008 and 2011. Patients were assessed for the survival of the implants, considering implant diameter and length, smoking status, diagnosis of diabetes, type of loss, and region of implant loss. In addition, a questionnaire with specific questions on the patients' satisfaction with the treatment was administered. Seventy-six implants were installed in the sampled patients, and only 1 loss was observed (late loss in the anterior maxilla region) after an average follow-up of 7.9 years, which corresponds to a 98.60% survival rate. The installed implants were of the most frequently used dimension (3.75 × 10 mm). One sampled patient was diabetic, and a second patient was both diabetic and a smoker. No loss of implants was observed in these 2 patients. All patients reported being completely satisfied with the treatment and would undergo the procedure again or refer it to a friend/relative. Six patients reported regular maintenance of the prosthesis, and only 3 had changed the prosthesis prior to the time of questionnaire administration. The results of this limited study with a restricted sample population suggest that the reconstruction of the maxilla with an autogenous iliac crest graft provides both adequate implant survival and patient satisfaction.

Clinical and Radiographic Evaluation of Reconstruction and Prosthetic Rehabilitation of mandibular resection defects using iliac grafts combined with implant placement

The aim of the current study was to evaluate efficacy of using iliac grafts combined with implants and retaining a provisional fixed-detachable (hybrid) prosthesis in the reconstruction of mandibular defects regarding average bone loss in graft height, peri-implant marginal bone loss, maximum bite force, facial asymmetry ,patient satisfaction and oral health quality of life (OHRQoL).Patients and methods: 11 patients were subjected to mandibular marginal resection with immediate reconstruction by autogenous iliac crest graft with implant placement. After 6 months they were rehabilitated with provisional screw-retained prosthesis. Radiographic assessment of average bone loss in graft height and marginal bone loss around dental implants was performed. Facial asymmetry, Maximum bite force, Patient satisfaction and oral health quality of life (OHRQoL) were assessed after the first surgery, at loading, 6 and 12 months later.Results: Average bone loss of graft height (mean 2.14±1.03). Average peri-implant Marginal bone loss after 1 year 1.42±0.38. The increase in marginal bone loss along the study period was significant (P<0.001). Maximum bite force of the rehabilitated side increased significantly along the study period. There was a statistically high significant difference between the scores of all OHIP-5 items scores except in the scores of the difficulty doing usual jobs item.Conclusion: Within the limitations of this study, it was concluded that construction of mandibular defect using iliac crest graft combined with dental implants and retaining a provisional fixed- detachable prothesis can be an effective procedure to restore bony defect, facial asymmetry, maximum bite force, patient satisfaction and oral health quality of life.

Linear and Volumetric Radiographic Assessment of Particulate Iliac bone grafts following Secondary Grafting of Unilateral Alveolar Clefts

Background: Particulate autogenous bone grafts remain to be the gold standard for reconstruction of alveolar. The success of alveolar bone grafting is assessed clinically and radiographically. Among the radiographic measures of success is the bone bridging across the cleft, maintenance of the bucco-palatal / vertical linear dimensions of the graft and the stability of the total volume of regenerated bridge of bone. Computed tomography (CT) scans provide a better tool for three-dimensional evaluation of the residual bone following the reconstruction procedure.Aim of the study: This study aimed at assessing the linear (horizontal, vertical) and volumetric changes that occur in particulate iliac bone grafts 6 months after secondary grafting of unilateral alveolar clefts.Patients and Methods: Six patients with unilateral alveolar clefts who received particulate autogenous iliac crest grafts were included in this study. On a surgical planning software, their immediate and six-months postoperative CT scans were superimposed onto each other using the cranial base as a reference. On the axial cuts, the linear bucco-palatal dimensions of the reconstructed alveolar cleft were recorded, whereas on the coronal cuts the vertical height of the reconstructed alveolar cleft was measured for both scans. The software was also used to calculate the volume of the bone graft on the immediate postoperative CT and that of the remaining bone graft 6 months after. The data was statistically analyzed in the form of means ± standard deviation and paired T-test used to compare the measurements immediately and six-months postoperatively. The percentage change in the alveolar ridge dimensions over the six months follow up period was then calculated.Results: The horizontal dimension of the grafted alveolar cleft decreased by an average of 24.4% over the six months period. The difference between the means showed a highly statistically significant difference with a P value < 0.01. While for the vertical dimension, the mean decreased by 21.6% over the six months period and the difference between the means was statistically significant with a P value Conclusions: Radiographic assessment of alveolar cleft reconstruction using CT scans are useful tools, not just for making accurate measurements and better evaluation of the formed bone within the reconstructed alveolar cleft, but also it provides a useful tool for analyzing the outcomes of the secondary alveolar grafting procedure for future correlation and optimization of the whole grafting procedure and expected outcomes.

Volumetric Cleft Changes in Treatment With Bone Morphogenic Protein/β-Tricalcium Phosphate Versus Grafts From the Iliac Crest or Symphysis

To compare the volumetric changes in successfully treated clefts with secondary alveolar grafting using recombinant human bone morphogenic protein-2 (rhBMP-2) delivered in β-tricalcium phosphate (βTCP) scaffold versus autogenous grafts obtained from the iliac crest and mandibular symphysis. We performed a retrospective cohort study of cone-beam computed tomography scans of 25 subjects with unilateral or bilateral clefts. Of the 25 patients, 7 received an iliac crest bone graft, 9 received a mandibular symphyseal bone graft, and 9 subjects received the rhBMP-2/βTCP bone substitute. Volumetric rendering software was used to calculate the amount of new bone formation and residual bone defect present in the cleft area. The data were analyzed using Wilcoxon and Kruskal-Wallis tests and Pearson's correlation coefficient. The mean percentage of new bone formation for the iliac crest, symphysis, and rhBMP-2/βTCP was 85.47, 80.56, and 81.22%, respectively (P=.0854). The initial cleft volume had a weak positive correlation with the percentage of new bone formation (r=0.18), but the postoperative residual cleft volume had a strong negative correlation (r=0.71). rhBMP2 delivered in a βTCP scaffold in alveolar cleft patients can be a viable alternative to autogenous iliac crest and symphysis grafts, eliminating donor site morbidity.

Autologous, and combined autologous, and hydroxyapatite granules in the treatment of benign bone lesions in children

Background Despite all established treatments, large bone cysts in children remain an unsolved problem. Bone grafts are often necessary to fill the defect, provide support, and enhance biological repair. Autogenous cancellous bone grafts usually from the iliac crest have been considered the gold standard. However, the limited quantity of a bone graft especially in children may limit its use. Calcium phosphate ceramics can be used to fill bone defects. These materials act as an osteoconductive bone-void filler that completely gets resorbed as newly formed bone remodels and restores anatomic features and structural properties. Aim of the work This study was carried out to assess the results of treatment of benign bone lesions in children using autologous bone graft either alone or in combination with hydroxyapatite (HA) granules. Patients and methods The study included 18 children having benign bone lesions. Their age ranged from 5 to 15 years (mean, 8.2±1.59 years). The resultant defect was filled with autogenous iliac crest graft in five (27.8%) patients in group I, and a combination of autogenous bone graft and G-bone HA granules in 13 (72.2%) patients in group II. The defect size ranged from 6 to 17 cm3 in group I (mean, 9.75±43.86 cm3), and from 11.5 to 115.5 cm3 in group II (mean, 43±33.92 cm3). The patients were followed up clinically and radiologically for a period that ranged from 12 to 56 months (mean, 17±11.41 months). Results The overall success rates were 80% for group I (four out of five) and 92.3% for group II (12 out of 13). Recurrence was met in one (20%) of five patients in group I, and one (7.7%) of 13 patients in group II. At the final follow-up, four of five patients in group I (80%) were considered Neer class I, and one (20%) patient was considered Neer class IV. Ten (77%) of 13 patients in group II were considered Neer class I, two (15.3%) patients were Neer class II, and one (7.7%) was Neer class IV. The differences in the results of both groups were statistically insignificant. Conclusion The use of HA synthetic granules with autogenous bone graft is a safe and effective option for the situations when a large amount of graft is needed especially in children with large and recurrent benign bone lesions.

Nonunion of Traumatic Lumbar Fracture: Case Report

Nonunion of flexion-distraction thoracolumbar fractures has few been described previously. The case report discussed a case of nonunion of traumatic lumbar fracture. A 30-year-old man suffered a traumatic L1-2 flexion-distraction fracture and no paraplegia. After complete bed rest 2 months, then hyperextension thoracolumbar cast 3 months, he still felt back pain when out-of-bed activity. X-ray images demonstrated the fracture was not united. At last, the patient underwent open reduction of the fracture nonunion and L1-2 posterior fusion using short segmental pedicle screw instrumentation with autogenous iliac crest graft. The patient gained an excellent functional restoration at 5 months after operation. This suggests that the disease entity may require surgical treatment as early as possible. Spinal fusion combined instrumentation fixation and bone graft may be the best treatment.

New Cage for Posterior Minimally Invasive Lumbar Interbody Fusion: a Study in Vitro and in Vivo

To design a new type of interbody fusion device made of nickel titanium NiTi shape memory alloy and to compare segmental stiffness after various posterior lumbar interbody fusion (PLIF) procedures in vitro and in vivo. Twelve sheep lumbar functional spinal units were randomly allocated to four groups. One acted as controls (N); the other three were treated with autogenous iliac crest bone dowel graft (L), a threaded cylindrical titanium (KC) interbody fusion device (TFC) or a new type of interbody fusion device made of NiTi shape memory alloy (NT) containing autogenous iliac crest graft. In addition, 15 sheep were allocated to three groups; one served as controls and the other two underwent TFC (KC) or NiTi-FC (NT). Nondestructive mechanical tests were performed in pure compression, extension, lateral bending and torsion. The operated spines were photographed regularly to assess changes in interbody height and degree of fusion. The animals were killed at 6 months for histologic testing. Biomechanical tests showed both the strength and axial stiffness of the NT and KC groups were significantly higher than those of the control group and L group (P < 0.05). When the mechanical performance in torque and torsion of each group were compared, the same results could be obtained. The maximal destructive load of the NiTi-TFC was 11 200 N and the safety coefficient was above 1.2. Radiological observations revealed that the bone callus around the interbody fusion device were gradually increased postoperatively (2 months, no obvious; 4 months, poorly define; 6 months, dense). The KC and NT group had lost 16% and 16.5% of their postoperative height but remained well above normal disc height (P < 0.05). Histologic examination showed new trabeculation connected with that of the host. The mechanical characteristics of the NiTi-TFC are excellent and it is safe and reliable.

The Volume Behavior of Autogenous Iliac Bone Grafts After Sinus Floor Elevation: A Clinical Pilot Study

Iliac crest is still regarded as one of the most viable source of autogenous graft materials for extensive sinus floor elevation. Three-dimensional resorption behavior has to be taken into account in anticipation of the subsequent insertion of dental implants. We performed 3-dimensional volume measurements of the inserted bone transplants in 11 patients (6 women and 5 men; mean age = 2.3 years) who underwent bilateral sinus floor elevation with autogenous iliac crest grafts. In order to determine the respective bone graft volumes, cone-beam computerized tomography studies of the maxillary sinuses were carried out directly after the operation (T0), as well as 3 months (T1) and 6 months (T2) postoperatively. The acquired DICOM (Digital Imaging and Communications in Medicine) data sets were evaluated using suitable analysis software. We evaluated statistical significance of graft volumes changes using a linear mixed model with the grouping factors for time, age, side, and sex with a significance level of P = .05. 38.9% of the initial bone graft volume, which amounted to 4.2 cm(3), was resorbed until T1. At T2, the average volume again decreased significantly by 18.9 % to finally reach 1.8 cm(3). The results show neither age nor side dependency and apply equally to both sexes. Without functional load, iliac bone grafts feature low-volume stability in sinus-augmentation surgery. Further clinical and animal studies should be done to detect the optimal timing for implant placement.

Short term analysis of healed post-tubercular kyphosis in younger children based on principles of congenital kyphosis

Background:The patients with healed severe progressive tubercular kyphosis may develop late-onset paraplegia. A particular subgroup of these children (Type IB progression) may benefit from the management principles of congenital kyphosis. Self-correction may be observed by selective continued growth of anterior vertebral epiphyseal end-plates over the posterior fused mass. We report a series of cases with posterior fusion of progressive post-tubercular kyphosis with an aim to prevent further progression of kyphosis and to assess if any gradual self correction is seen in followup.Materials and Methods:Twelve children fulfilling inclusion criteria of clinicoradiological, hematological diagnosis of healed spine TB having no or <2 spine at risk signs having documented progression of kyphosis and neural deficit underwent posterior fusion in situ without instrumentation, using autogenous iliac crest grafts as well as allograft donor bone graft. They were followed up to maximum of 5 years.Results:All 12 children had a progressive increase in angle preoperatively. Mean followup was 3.6 years. Post surgery, 66% showed a clinical improvement and correction, 25% had static angle, and worsening in one patient. Thus, overall 91% have a favorable result.Conclusion:The mechanism of correction of deformity in presence of posterior fusion is continued growth of the anterior epiphyseal end plates and hence this leads to selective differential anterior column growth giving gradual correction of kyphosis. This avoids anterior, technically demanding and complex, internal gibbus surgeries. This procedure is simple, safe, and less morbid with good results, avoiding long term disability to the patients in selected group of patients.

Report of a Case of Genu Recurvatum Following Tibial Eminence Avulsion Treated by Proximal Tibial Flexion Osteotomy and Review of the Literature

We report a case of acquired genu recurvatum treated with a proximal tibial flexion osteotomy. A partial growth arrest at the anterior portion of the proximal tibial physis following a conservatively treated Meyers-McKeever type II injury of the tibial eminence. This is a reliable method in the correction of genu recurvatum. By using tricortical autogenous iliac crest graft, the osteotomy may be made very stable intra-operatively circumventing the need for fixation.

Comparison of stand-alone polyetheretherketone cages and iliac crest autografts for the treatment of cervical degenerative disc diseases

Anterior cervical decompression and fusion (ACDF) is a widely accepted surgical procedure for the treatment of cervical degenerative disc diseases. This retrospective study was designed to analyze and compare the efficacy and outcomes of anterior cervical fusion using stand-alone polyetheretherketone (PEEK) cages and autogenous iliac crest grafts with the anterior cervical plating system. A total of 72 consecutive patients suffering from cervical degenerative disc diseases treated with ACDF from June 2005 to Dec 2008 were enrolled in the study. Patients in group A (40 patients, 64 segments) had anterior interbody fusion with stand-alone PEEK cages and patients in group B (32 patients, 51 segments) with autogenous iliac crest graft combined with anterior plate fixation. The operative time and intraoperative blood loss were recorded. Clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) scoring system; cervical lordosis, intervertebral height, and cervical fusion status were assessed on X-ray and computed tomography. The mean follow-up period was 17.3 months in the stand-alone cage group and 23.2 months in the autologous iliac crest graft group. The operative time and intraoperative blood loss in group A were much less than those in group B (p < 0.05). All the patients in both groups got complete interbody fusion. Postoperative JOA scores in both group A and group B were more than the preoperative ones with significant differences, and the improvement rate of JOA scores had no statistical differences between group A and group B. Postoperative cervical physiological curvature and intervertebral height in both groups were better than the preoperative ones with statistical significances. The stand-alone PEEK cage is a good substitute for fusion in patients with cervical disc disease; it can effectively restore the cervical physiological curvature and the intervertebral height, facilitate radiological follow-up, cause few complications, and leads to satisfactory outcomes.

Efficacy of Iliac Crest vs. Medpor in Orbital Floor Reconstruction.

The present study is to compare the effectiveness of iliac crest graft and medpor implant, for repairing traumatic orbital floor defects. A total of 20 patients were included in the study. Autogenous iliac crest graft and medpor implant was used in 10 patients of the each group. Patients were evaluated for the presence or absence of diplopia, enophthalmos, infraorbital nerve paresthesia, and ocular motility disorders. Surgical indications for orbital exploration included entrapment of orbital tissues, large orbital defect (greater than 50% of the orbital floor or more than 8mm), or orbital floor defects with involvement of other zygomaticofrontal complex fractures. All patients were successfully treated by restoration of the orbital wall continuity. Follow-up was done at 1-12weeks. One patient had postoperative infection. There was no graft extrusion. Both the groups showed satisfactory results, but group II was better than group I, as there was no donor site morbidity. Porous polyethylene (Medpor) is a biocompatible and high-density polyethylene implant. It is well tolerated by surrounding tissue, and its porous structure is rapidly infiltrated by host tissue. It is a highly stable and somewhat flexible porous alloplast that has rapid tissue in growth into its pores.

Are the additional grafts necessary?

The goals of surgery for spinal deformity are to correct or improve the deformity to get a stable, balanced and fused spine. The long-term success of any procedure for scoliosis depends on a solid arthrodesis. Getting fusion of the instrumented segment with the aid of copious autogenous iliac graft has been the most important goal of treatment. However, harvesting copious graft from teenage iliac bone has its limitation in the quantity of graft, surgical time, and other complications of graft sites. Bone substitute is a promising concept, but there is not ideal bone substitute with all the characteristics of an autogenous bone graft. Several alternative graft materials like tricalcium phosphate, hydroxyapatite, and demineralized bone matrix have osteoinductive properties. Bone morphogenic protein has osteoconductive properties. The limitations with bone substitutes are osteoinduction and osteoconduction properties, sterilization, chances of transmitting infective disease and cost. We consider that the introduction of segmental spinal instrumentation which enables strong and firm correction and fixation of the scoliotic deformity has enabled getting fusion with less graft. We can obtain that quantity of graft after laminae and spinous process decortication. This retrospective study has been done in our hospital from January 2002 to December 2004. A total of 188 patients underwent posterior corrections for adolescent idiopathic scoliosis using segmental fixation by Moss-Miami. No autogenous iliac crest graft was taken or graft substitutes. After meticulous decortication and destruction of facet joints, we used local graft taken from spinous process and laminae. All patients had minimum thirty months follow-up. We have excellent results. Out of these 188 patients, 177 patients have fused spine, no implant failure, no pain, no infection and no loss of correction. Eleven (5.8%) patients underwent re-operation; four among them because of infection, three for symptomatic implants and four due to pseudarthrosis. We consider that the use of local harvesting graft is enough for getting good spondylodesis.