scholarly journals Novel bone grafting technique in stand-alone ALIF procedure combining allograft and autograft (‘Northumbria Technique’)—Fusion rate and functional outcomes in 100 consecutive patients

2021 ◽  
Author(s):  
Ata George Kasis ◽  
Cyrus Jensen ◽  
Rahul Dharmadhikari ◽  
Benjamin Ross Emmerson ◽  
Matthew Mawdsley
Keyword(s):  
Donor Site ◽  
Fusion Rate ◽  
Patient Reported Outcome ◽  
Iliac Crest Bone Graft ◽  
Donor Site Pain ◽  
Grafting Technique ◽  
Patient Reported ◽  
Fresh Frozen ◽  
Solid Fusion ◽  
Synthetic Agents

Abstract Introduction Successful ALIF surgery depends upon achieving solid fusion, whilst avoiding significant complications. Herein, we present the ‘Northumbria Technique’ of combining allograft with autograft in order to achieve solid interbody fusion. Materials and Methods A single-surgeon series of 100 consecutive patients undergoing stand-alone ALIF from 2016 to 2019 was studied. All had percutaneously harvested iliac crest bone graft (ICBG) dowels inserted into blocks of fresh frozen femoral head (FFFH) allograft, which were then inserted into the ALIF cages. Patients had dynamic radiographs at 4 months, CT at 6 months, and patient reported outcome measure scores (PROMS) throughout. Results One hundred patients (average age 44.8 years) were followed-up for an average of 29.1 months. Ninety-four (94%) patients were assessed as having fused on both CT and radiographs by an independent Radiologist. Three (3%) patients had abolition of movement on radiographs, but either lacked a CT scan or failed to meet Williams criteria for fusion. Two patients failed to attend for any imaging, so were considered not fused, and one patient had no evidence of fusion in either modality. There was a significant improvement in all PROMS. There were no intra-operative complications, and one patient had transient donor-site pain. Conclusions The newly described ‘Northumbria Technique’ utilises the osteoconductive characteristics of the FFFH allograft, as well as the osteoinductive and osteogenic properties of the ICBG autograft. It gives high fusion rates (94–97%) and statistically significant improvements in PROMS, whilst avoiding the complications of harvesting a large amount of autograft and the huge costs of using synthetic agents.

scholarly journals ANTERIOR CRUCIATE LIGAMENT RECONSRUCTION IN CHILDREN: OUTCOMES OF QUADRICEPS VERSUS HAMSTRING AUTOGRAFTS

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0006
Author(s):  
Joshua T. Bram ◽  
Itai Gans ◽  
Robert Parisien ◽  
Elliot Greenberg ◽  
Theodore J. Ganley
Keyword(s):  
Pediatric Patients ◽  
Cruciate Ligament ◽  
Cohort Analysis ◽  
Donor Site ◽  
Peak Torque ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Donor Site Pain ◽  
Patient Reported ◽  
Torque Values

Background: Emerging evidence has suggested reduced donor site pain and equivalent/improved functional outcomes in adults undergoing ACL reconstruction (ACLR) with quadriceps (QT) autograft versus hamstrings (HT) grafts. No studies in children comparing QT versus HT autografts have assessed postoperative strength or active range of motion (AROM) in addition to more commonly accepted patient-reported outcome measures (PROMs). Hypothesis/Purpose: The purpose of this study was to directly compare clinical and patient-reported outcomes of pediatric patients undergoing QT and HT autograft ACL reconstructions. We hypothesized that use of QT autografts would result in similar clinical and PROMs to HT autografts. Methods: A retrospective cohort analysis of pediatric patients (≤18 years) undergoing primary transphyseal ACLR from 1/2018-12/2019 without concomitant multiligamentous reconstruction was conducted. Outcomes at 3 and 6 months, including isokinetic strength testing, PROMIS and IKDC scores, and AROM were compared between patients receiving either HT or QT autografts. Hamstrings to quadriceps (H/Q) ratios were calculated using the ratio of the respective peak torque values normalized to body weight. Multiple imputation was utilized to minimize bias resulting from missed follow-up appointments. Results: 84 patients met inclusion criteria (Table 1). The 40 patients receiving QT were more often male (62.5% vs 34.1%, p=0.009). There were no differences in operative time (p=0.053) or proportion of patients requiring meniscus repair (p=0.958). At 3 months postoperative, those with HT had lower H/Q ratios (62.2 ± 15.8 vs 78.6 ± 19.9, p<0.001) and limb symmetry index (LSI) in flexion (86.1 ± 17.1 vs 94.3 ± 17.6, p=0.042), while patients with QT had lower LSI in extension (66.8 ± 13.2 vs 77.3 ± 12.6, p=0.001). The H/Q ratio was also lower at 6 months among patients receiving HT (59.7 ± 11.2 vs 66.3 ± 8.2, p=0.004). IKDC, PROMIS physical function, and PROMIS pain interference scores were not different between cohorts at either 3 or 6 months. There was no difference in AROM in flexion or extension between groups at all postoperative visits. Patients with QT were more likely to have a postoperative wound issue (20.0% vs 2.3%, p=0.012). Conclusion: Significant differences in quadriceps and hamstrings strength at 3 months were observed for ACLR patients by graft type. This contributed to higher H/Q ratios at 3 and 6 months postoperatively for patients receiving QT. QT grafts appear to have a higher rate of postoperative infection/wound issues. Tables/Figures: [Table: see text]

Distal Tibia Bone Graft for Arthrodesis of the Foot and Ankle

1995 ◽  
Vol 16 (4) ◽  
pp. 187-190 ◽  
Author(s):  
Marc B. Danziger ◽  
Richard V. Abdo ◽  
J. Elliot Decker
Keyword(s):  
Bone Graft ◽  
Disease Transmission ◽  
Donor Site ◽  
Distal Tibia ◽  
Iliac Crest Bone Graft ◽  
Heterotopic Bone ◽  
Heterotopic Bone Formation ◽  
Foot And Ankle ◽  
Ankle Motion ◽  
Donor Site Pain

Forty patients since 1988 have had distal tibial bone grafting for 41 arthrodeses of the foot and ankle. Bone graft is obtained through a cortical window made just above the medial metaphyseal distal tibial flare. Average follow-up was 23.3 months. Forty of 41 arthrodesis sites fused; there was only one nonunion. There were no delayed unions. There were no complications at the donor site based on patient examination and radiographs. Ipsilateral ankle motion was not affected by the bone graft procedure. Cited complications from iliac crest bone graft include donor site pain, blood loss, heterotopic bone formation, pelvic instability, iliac hernia, infection, fracture, and deformity. Complications with allografts include disease transmission and immune response. These are avoided by using locally obtained distal tibia autograft for arthrodeses in the foot and ankle.

Autograft versus allograft with or without demineralized bone matrix in posterolateral lumbar fusion in rabbits

2008 ◽  
Vol 9 (1) ◽  
pp. 84-89 ◽  
Author(s):  
Julio Urrutia ◽  
Nicolas Thumm ◽  
Daniel Apablaza ◽  
Felipe Pizarro ◽  
Alejandro Zylberberg ◽  
...  
Keyword(s):  
Demineralized Bone Matrix ◽  
Lumbar Fusion ◽  
Donor Site ◽  
Bone Matrix ◽  
Rabbit Model ◽  
Fusion Rate ◽  
Iliac Crest Bone Graft ◽  
Fisher Exact Test ◽  
Group I ◽  
Demineralized Bone

Object Posterolateral spinal fusions are performed to treat different spinal disorders. Autograft continues to be the gold standard; it is, however, associated with donor site morbidity and limited sources. Allograft has been used, but has been reported to result in lower fusion rates. Demineralized bone matrix (DBM) has also been used and reportedly increases the fusion rate in a variety of critical defect models. Different forms of DBM are available, not all have been independently studied. To evaluate the effect of a xenogenic DBM added to allograft on the fusion rate of posterolateral lumbar spine arthrodesis the authors designed an experimental study comparing posterolateral fusion rate using autograft, allograft, and allograft plus a xenogenic DBM in a validated animal model. Methods A bilateral, 1-level (L4–5) intertransverse process fusion was performed in 45 male New Zealand rabbits. Iliac crest bone graft was harvested bilaterally from each rabbit. The rabbits were randomly assigned to 3 groups: Group I, Autograft, 15 rabbits; Group II, Allograft, 15 rabbits; and Group III, Allograft plus DBM in a paste form (Dynagraft). The animals were killed 8 weeks after surgery. Fusion was assessed radiographically and by manual palpation by 2 independent observers. The results were analyzed using the Fisher exact test and chi-square test. Results The fusion rate was 46.6% (7 of 15 rabbits) in the autograft group, 33.3% (5 of 15 rabbits) in the allograft group, and 33.3% (5 of 15 rabbits) in the allograft plus DBM group (p > 0.05). Conclusions Autograft produced a higher fusion rate than allograft in this spinal fusion rabbit model, but the difference was not statistically significant. Allograft plus xenogenic DBM showed the same fusion rate as allograft alone.

In Scaphoid Non-Union, Does the Source of Graft Affect Outcome? Iliac Crest Versus Distal End of Radius Bone Graft

2006 ◽  
Vol 31 (1) ◽  
pp. 47-51 ◽  
Author(s):  
A. D. TAMBE ◽  
L. CUTLER ◽  
S. R. MURALI ◽  
I. A. TRAIL ◽  
J. K. STANLEY
Keyword(s):  
Bone Graft ◽  
Iliac Crest ◽  
Donor Site ◽  
Bone Grafts ◽  
Biomechanical Properties ◽  
Osteogenic Potential ◽  
Iliac Crest Bone Graft ◽  
Non Union ◽  
Treatment Groups ◽  
Donor Site Pain

Iliac crest bone grafts are sometimes preferred to other bone grafts for the treatment of non-unions of fractures of the scaphoid as they are claimed to have better osteogenic potential and biomechanical properties. We retrospectively studied a consecutive cohort of 68 symptomatic established scaphoid non-unions treated by bone grafting. An iliac crest graft was used in 44 cases and a distal radius graft in the other 24. The two treatment groups were comparable in terms of location of the fracture, duration of the non-union and the fixation implants used. Overall union was achieved in 45 of the 68 patients (66%) and the union rate was not influenced by the type of bone graft used. Twenty-nine of the 44 treated with iliac crest bone graft (66%) and 16 of the 24 (67%) treated with distal radial graft united. Donor site pain over the iliac crest was present in nine of the 44 patients in this group.

Cleft Patient-Reported Postoperative Donor Site Pain Following Alveolar Autologous Iliac Crest Bone Grafting

2015 ◽  
Vol 26 (7) ◽  
pp. 2099-2103 ◽  
Author(s):  
Cesar Augusto Raposo-Amaral ◽  
Rafael Denadai ◽  
Danilo Zanardo Chammas ◽  
Frederico Figueiredo Marques ◽  
André Silveira Pinho ◽  
...  
Keyword(s):  
Bone Grafting ◽  
Iliac Crest ◽  
Donor Site ◽  
Iliac Crest Bone Grafting ◽  
Donor Site Pain ◽  
Patient Reported ◽  
Site Pain

Contribution of recombinant human bone morphogenetic protein—2 to the rapid creation of interbody fusion when used in transforaminal lumbar interbody fusion: a preliminary report

2004 ◽  
Vol 1 (1) ◽  
pp. 19-23 ◽  
Author(s):  
Praveen V. Mummaneni ◽  
Jeff Pan ◽  
Regis W. Haid ◽  
Gerald E. Rodts
Keyword(s):  
Interbody Fusion ◽  
Iliac Crest ◽  
Donor Site ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Content Type ◽  
Donor Site Pain ◽  
Solid Fusion ◽  
Group 2 ◽  
Site Pain ◽  
Fine Print

Object. The authors compared fusion rates in transforaminal lumbar interbody fusion (TLIFs) when using either autograft or bone morphogenetic protein (BMP) placed in the interbody space. Methods. Between September 2002 and December 2003, the authors performed 44 TLIF operations. Follow-up data were available for 40 patients. Of the 40 procedures, 19 involved cages filled with iliac crest autograft (Group 1) and 21 involved cages filled with a medium kit of recombinant human (rh) BMP-2 (Group 2). In all Group 2 patients, one BMP sponge was placed anterior to the cage and another was placed within the cage. In 12 of the Group 2 patients, iliac crest autograft was placed posterior to the BMP-filled cage (Group 2A). In the remaining nine Group 2 patients, only local autograft was placed posterior to the BMP-filled cage (Group 2B). Assessment of fusion was performed using dynamic radiography at 3-month intervals. Outcomes were assessed using the Prolo Scale, and iliac crest donor site pain was measured using a Visual Analog Scale (VAS). The mean follow-up period was 9 months (range 3–18 months). In Group 1 patients, one pseudarthrosis was detected. In Group 2 patients, dynamic radiography demonstrated solid fusion in all patients except one in Group 2B. Fiftyeight percent of patients in whom iliac crest autograft was used complained of donor site pain 6 months after surgery (5 of 10 points on the VAS). Symptomatic foraminal bone formation was not observed in any Group 2 patient. Conclusions. The use of rhBMP-2 is safe in TLIFs when the sponges are placed away from the dura mater, and BMP promotes a more rapid fusion than iliac crest autograft alone. The use of rhBMP-2 in combination with local autograft is an excellent option for promoting solid fusion with TLIF, and it eliminates the possibility of iliac donor site pain.

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