Autologous Tricortical Graft Research Articles

Open wedge high tibial osteotomies: Calcium-phosphate ceramic spacer versus autologous bonegraft

Valgus tibial osteotomy (VTO) is a well-known procedure for the treatment of medial compartment femoro-tibial osteoarthritis. Good and very good results have been reported with calcium phosphate wedges, which avoid the inconveniences of autologous grafts use. The hypothesis of this study is that with equivalent results in the treatment of osteoarthritis of the knee, the use of calcium phosphate wedges (BMCaPh) to fill the bone defect created by osteotomy would result in fewer specific complications and less pain associated with autologous grafts (AUTO) harvesting. This prospective, controlled, randomised study included one arm that received a macroporous, biphasic calcium phosphate wedge (BMCaPh group) and one arm that received an autologous tricortical graft (AUTO group) for filling. The same plate with locked screws was used for fixation in all cases. All patients underwent at least two years of clinical and radiographic post-operative follow-up. Forty patients were included. Loss of correction occurred in six of the twenty-two patients in the BMCaPh group (27%), resulting in three early surgical revisions, compared to one loss of correction in the AUTO group. Lateral cortical hinge tears were a risk factor for loss of correction for the entire cohort and in the BMCaPh group. (relative risk 13.3 [1.9-92]. Moreover, union took significantly longer and pain lasted significantly longer in the BMCaPh group, although results were comparable at 6months. A significant number of undesirable events (loss of correction) occurred in this study, limiting the number of included patients. Nevertheless, the results show that although there was no difference in the two groups for overall complications, number of revisions all causes combined, or clinical results, filling with BMCaPh was less tolerated and increased the risk of loss of correction when local mechanical conditions of the knee were unfavourable (lateral cortical hinge tears). Moreover, although it is not possible to draw a conclusion because of methodology bias in this study, early weight-bearing resumption on the knee also seemed to favour these complications. LevelII. Prospective randomized study.

Anterior approach for traumatic lesions of the lower cervical spine: long-term results

Purpose The purpose of this study is to assess the long-term results obtained by surgical treatment of severe lower cervical spine injuries by means of an anterior approach. We also carry out a review of the literature on the subject. Materials and methods Retrospective study of 32 patients with traumatic injuries in their low cervical spine, treated by means of anterior arthrodesis with a tricortical graft and locking plate fixation. Mean age was 33.7 years (range: 13-54). The most frequent mechanism of injury was fall from height in 13 cases, road accident in 18 and one case of an accident in the course of water sports practice. Mean follow-up was 10.2 years (range: 4.3-19.5). Results In all but one of our patients we obtained solid fusion at 3 to 6 months. Radiologically we observed 100% height restoration, recovery of physiologic cervical lordosis (>20°) in 70% of patients and anatomic reduction in 87%. Resumption of previous occupation was possible for 23 patients (71.87%); the same number of patients was capable of performing basic activities of daily living without feeling any symptoms. Conclusions Although there is no unanimity as regards the best treatment for traumatic injury to the lower cervical spine, anterior decompression, accompanied by the use of a structural autologous tricortical graft and stabilization by locking plates, is considered the best option for most of these lesions.

Minimal Invasive Anterior Decompression in Tuberculosis of Thoracolumbar Junction of the Spine – Experience With SynFrame

This study assesses the role of new retractor system SynFrame for anterior decompression of tuberculosis of thoracolumbar junction of the spine. This study includes five consecutive patients with tuberculosis of thoracolumbar junction treated with minimal invasive anterior decompression using a new table mounted retractor system SynFrame (Stratec Medical, Switzerland). The thoracolumbar junction was approached by a left sided thoracotomy. Short construct pedicle screw stabilization was done in all cases before decompression. The anterior column was reconstructed using expandable cage (n=3) and autologous tricortical graft (n=2). The mean operating time was 100 minutes (range 90-120). Mean overall blood loss was 400 ml. No operation had to change into an open procedure. There were neither intra nor postoperative complications related to minimal access in particular, nor visceral/vascular complications. The ring retractor system allows minimal open surgery to the spine by carrying different devices as well as endoscope, providing an excellent visualization of the operating field, and is safe and easy to use. The only disadvantage is its high cost.