Abstract
Study Design: A prospective randomised controlled trial with blind radiological assessment.
Objective: To assess the radiological outcome of instrumented posterolateral lumbar fusion in a prospective randomised study comparing the use of allograft (fresh frozen human femoral head) to autologous bone (from the posterior iliac crest) using a validated method.
Methods: Sixty-nine patients having instrumented postero-lateral fusion using the Steffee plate were randomised to one of two groups, to receive either allograft bone or autologous bone. The same surgeon using the same surgical technique performed or supervised all cases. The radiological results of the two groups were assessed as well as the quality of fusion.
Outcome measures: The radiographs were assessed for fusion or non-fusion by three independent observers using the same criteria, and a second time by one of the observers. The Kappa scores for the inter-observer and intra-observer agreement were calculated. Some of these patients had fusion status verified by the gold standard of surgical exploration and the sensitivity and specificity calculated. The clinical outcome is the subject of a different paper.
Results: Both the inter-observer and intra-observer kappa scores (k) were 100%. The sensitivity of the method was 87.9% and the specificity was 100%. Thirty-seven patients received allograft and 32 patients received autograft. There was no significant difference in the fusion rate, or the quality and quantity of the graft between the groups.
Conclusions: There is no difference in the fusion rates comparing the use of autograft and allograft for postero-lateral instrumented lumbar fusion.
These abstracts were prepared by Mr. Brian J C Freeman FRCS (Tr & Orth). Correspondence should be addressed to him at The Centre for Spinal Studies and Surgery, University Hospital, Queens Medical Centre, Nottingham NG7 2UH.
