EPOS / IPOS Combined Meeting
12 - 14 April 2007
Fusion Rates Following
Thoracoscopic Release and
Bone Graft Substitutes in
Brett T Weinzapfel, MD, PhD, Jochen P Son-Hing, MD
Douglas G Armstrong, MD, Laurel C Blakemore, MD, Connie
Poe-Kochert, RN, CNP, George H Thompson, M.D.
Rainbow Babies and Children’s Hospital
Case Western Reserve University
Between 1998 and 2004, thoracoscopic
anterior discectomy and
fusion followed by PSF
and SSI was performed
in 47 patients with
40 patients have been followed more
than one year.
12 patients had morselized allograft
bone placed in the disc spaces
28 patients had Grafton DBM Flex
contoured and folded into "tacos" to
fill the disc spaces (DBM group).
Grafton DBM Flex
10 cm x 2.5 cm sheet ~
Cut into squares
Folded in half , corners
placed into disc spaces
Expands as it rehydrates
Grafton Flex “Tacos”
Patients were evaluated at one month,
one year, and at last follow-up.
Major curves were measured using the
Interbody fusion was assessed using the
grading scale for plain radiographs as
reported by Newton et al.
Radiographs were blinded
Grade I—uniform bone
filling of disc space
Grade II—bone formation
> 50% of disc space.
Grade III— bridging bone
< 50% of disc space.
Grade IV—no bone
formation or presence
The mean follow-up was 4.3 ± 1.8 years in
the allograft group and 2.6 ± 1.1 years in
the DBM group.
There were no significant differences in
age at surgery, number of vertebrae
fused, or estimated blood loss.
No patient had crankshaft, pseudarthrosis
or hardware failure.
At most recent assessment, 160 of 182 disc
spaces (88%) were rated grade I or II.
No significant differences between the two
Grafton DBM Flex "tacos" are an
effective bone graft substitute in
thoracoscopic surgery for idiopathic