Abstract
Introduction and Aims: Autologous bone is the preferred method of providing structural support in spinal surgery. The disadvantages are donor site morbidity and limited bone available to reconstitute the anterior column. We evaluated fresh frozen femoral allografts following anterior column reconstruction for lumbar burst fractures with neurological deficit.
Method: Twenty-seven patients with neurological deficit ( Frankel grade A(3), B(7), C(16) D (1) due to burst fractures of the dorsolumbar junction were treated with fresh frozen allografts following anterior spinal decompression. The average age was 28 years, and 19 patients sustained the injury following a road traffic accident.
The mean pre-operative kyphosis measured 190. A corpectomy was performed in all patients and femoral allografts were positioned by interference fit and the spine stabilised with an anterior rod screw construct. The radiographs were reviewed at three-monthly intervals and the fusion graded by an independent radiologist.
Results: The follow-up in 24 patients ranged from 29 to 72 months (mean 43 months) and three patients were excluded due to inadequate follow-up. Allograft incorporation was assessed by criteria of Bridwell et al grade 1 fused with remodelling with cross trabeculae into the adjacent vertebral bodies, grade 11 graft intact, not fully remodelled and incorporated, no lucenies, grade 111 graft intact, but a definite lucency at the top or bottom of the graft, grade 1V not fused with resorption and collapse of graft. The allografts were stable and evidence of graft incorporation and remodelling were observed between eight and 24 months. Grade 1 fusion was seen in 23 patients at two years and subsequent follow-up revealed no fracture, resorption or collapse.
The average neurological recovery, which was 1.4 Frankel grades (range 0–2 grades), occurred within seven weeks following surgery (range 11–74 days).
Nine patients (37%) made a complete recovery and in four patients (16%) there was no improvement. The mean post-operative kyphosis at two years was 80 (range 2–180). At seven-year follow-up one patient had an asymptomatic grade 11 fusion following secondary infection due to TB which was successfully treated.
Conclusion: The indications for the operative treatment of thoracolumbar burst fractures remains controversial. The increased compressive strength of allografts, the large surface of contact, and the stability with instrumentation created a stable construct, which permitted early mobilisation. Allografts were inexpensive biological alternatives to reconstruct the anterior column in burst fractures.
These abstracts were prepared by Editorial Secretary, George Sikorski. Correspondence should be addressed to Australian Orthopaedic Association, Ground Floor, The William Bland Centre, 229 Macquarie Street, Sydney, NSW 2000, Australia.
One or more of the authors are receiving or have received material benefits or support from a commercial source.
