Introduction: Traumatic spinal injury presents the potential for significant morbidity and mortality, and posterior fixation and fusion with bone grafts is a primary treatment for many vertebral fractures. While iliac crest autograft (ICBG) is considered the gold standard in bone grafting, this carries risks of morbidity at the donor site as well as prolonging surgery time. Bone graft substitutes (BGS) may provide a viable alternative to autograft but there is little published data concerning its use in trauma. Therefore, we conducted this retrospective review to evaluate the outcomes for fusion among patients who have received a BGS during posterolateral fusion (PLF) for vertebral trauma.
Materials and methods: This was a retrospective, consecutive patient cohort. Over a six-month period, we identified 27 patients who had undergone PLF for spine trauma and in whom a BGS comprised of bovine-derived apatite was used. All patients had followed the standard of care. The postoperative plain film radiographs at three, six, 12, and (optionally) 24 months were independently assessed by an orthopedic surgeon who was not affiliated with the hospital.
Results: We documented a radiographically observed fusion rate of 85% and a successful treatment rate of 92%. There were no adverse events related to the BGS. Patients who received a BGS with ICBG spent significantly longer in surgery than other patients. There were no adverse events related to the BGS.
Conclusions: The spondylodesis rate following surgery in which the BGS was used in PLF, whether alone, mixed with local bone, or mixed with ICBG is comparable to the rates that have been reported for iliac crest autograft in these indications. The data indicates that the BGS provides a useful adjunct in PLF for the treatment of traumatic spine vertebral injuries. The use of BGS also allows for shorter time in surgery, which may reduce resource utilization and thus lower the total costs of the procedure.
Clinical relevance: Posterolateral fusion can be obtained with the use of a bio-derived BGS while reducing the time in surgery by avoiding the second procedure necessary to harvest ICBG. This may be advantageous in cases where the surgeon wishes to minimize operating time or when the availability of autograft is limited.