Abstract
Objectives: To evaluate the clinical and radiological outcome following anterior interbody fusion using a femoral cortical allograft packed in the centre with autogenous iliac graft combined with posterior pedicle fixation.
Design: A prospective study of 30 consecutive adult patients diagnosed with lumbar degenerative disc disease.
Summary of background data: Various fusion options have been described in the literature with various clinical and radiological outcomes. Narrowing of the disc space is thought to be the primary cause of all the potential secondary spondylotic changes; the ideal corrective surgery would be one that reconstitutes the disc space interval. A hybrid graft consisting of a femoral cortical allograft (FCA) ring packed in the centre with autogenous cancellous iliac graft seems to be an ideal option as one should capitalize on the mechanical strength of the cortical ring and the biological strength of the cancellous autogenous graft.
Methods: 15 patients with failed back surgery, 15 patients with primary degenerative disc disease. Mean age was 43 years. All patients had preoperative radiographs, MRI scanning, discography was not used in this study. All femoral allografts were processed by freeze drying and sterilized using ethylene oxide. The protocol for surgery consisted of:
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* Left sided retroperitoneal muscle splitting approach
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* Anterior hybrid interbody grafting
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* Pedicle screw fixation without grafting
Results: There were no complications from using the allograft. Intraoperative and postoperative complications were seen in 3 patients. After a minimum follow up of 2 years good clinical outcome was achieved in 83 % using Ricciardi et al criteria, solid fusion was achieved in 98%.
Conclusion: The results in this study continue to support the efficacy of using hybrid interbody grafts to achieve a successful fusion, however there is discrepancy between the radiological and clinical outcome which merits additional investigations
The abstracts were prepared by Editorial Secretary, Dr Charles Pither. Correspondence should be addressed to SBPR at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PN
