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Posterolateral fusion with local bone vs. iliac crest bone graft occurs at similar rate
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 Miyako Suzuki |
GOTHENBURG, Sweden — Investigators from Chiba University in Chiba, Japan, who sought to determine whether using local bone graft is as effective as iliac crest bone graft in cases of L4 degenerative spondylolisthesis found fusion rates of 90% and 85%, respectively, in 1-level instrumented cases they evaluated.
Furthermore, they observed fusion at nearly the same point postoperatively in the 42 local bone graft (LBG) cases and 40 iliac crest bone graft (ICBG) cases studied, all of which included an L4/5 decompression, according to investigators.
Among the highlights of the prospective, randomized study that Miyako Suzuki presented here at the International Society for the Study of the Lumbar Spine Annual Meeting 2011 were the Visual Analog Scale and Japanese Orthopaedic Association scores preoperatively vs. 2-years postoperatively.
She also discussed the complications with both types of bone grafting.
“There were no significant differences in the rate of bone union and the average period for bone union, evaluated by X-ray and CT, between the two groups,” Suzuki said. “There was no significant difference in blood loss between the two groups, however, surgical time in the LBG group was significantly shorter than that of the ICBG group.”
In the ICBG group, 8 patients lost sensation around the iliac crest and 6 patients had donor site pain that was significant.
“The extent of complications in the ICBG group was significantly higher than in the local bone graft group,” Suzuki said.
LBG used in the study consisted of the spinal processes and lamina at L4 and L5, while ICBG was harvested from the left iliac bone. It came out in the paper’s discussion that differing amounts of bone graft were used with the two grafting techniques and, more importantly, that they have discontinued using this particular LBG technique, despite its apparent advantages over ICBG in this study.
Reference:
- Suzuki M, Ohtori S, Koshi T, et al. Single-level instrumented posterolateral fusion of the lumbar spine with a local bone graft versus an iliac crest bone graft: A prospective, randomized study with 2-year follow-up. Paper #P49. Presented at the International Society for the Study of the Lumbar Spine Annual Meeting 2011. June 14-18. Gothenburg, Sweden.
Local bone can mean different things to different surgeons. I think most of us when we say local bone, we would usually use lamina bone and maybe a little bit of the spinous process that is adjacent, just bordering on the gap between L4/5, but not the entire part, because the upper part of L4 would serve very strong ligament attachment to L3 and the lower part of L5 would serve a very strong attachment to the ligaments between L5 and S1. We try to preserve these ligaments. I can see that because of that, they have actually discontinued doing this.
— Prof. Wong Hee Kit
Chair, University
Orthopaedics, Hand & Reconstructive Microsurgery Cluster
National
University Health System, Singapore
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