Fusion Rates Following Thoracoscopic Release and Bone Graft by kse10139

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									             EPOS / IPOS Combined Meeting
                     Sorrento, Italy
                  12 - 14 April 2007


      Fusion Rates Following
    Thoracoscopic Release and
     Bone Graft Substitutes in
       Idiopathic Scoliosis
   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
                       Cleveland, OH
            Patients
Between 1998 and 2004, thoracoscopic
  anterior discectomy and
  fusion followed by PSF
  and SSI was performed
  in 47 patients with
  idiopathic scoliosis.
40 patients have been followed more
  than one year.
          Study Groups
12 patients had morselized allograft
  bone placed in the disc spaces
  (allograft group).
28 patients had Grafton DBM Flex
  contoured and folded into "tacos" to
  fill the disc spaces (DBM group).
           Grafton DBM Flex
Demineralized Bone
  Matrix
10 cm x 2.5 cm sheet ~
  $1250
Cut into squares
Folded in half , corners
  rounded (tacos)and
  placed into disc spaces
Expands as it rehydrates
  with blood
Grafton Flex “Tacos”
           Evaluations
Patients were evaluated at one month,
  one year, and at last follow-up.
Major curves were measured using the
  Cobb method.
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
 with trabecular
 remodeling.
Grade II—bone formation
 > 50% of disc space.
Grade III— bridging bone
 < 50% of disc space.
Grade IV—no bone
 formation or presence
 of osteophytes.
                Results
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
groups.
          Conclusions
Grafton DBM Flex "tacos" are an
 effective bone graft substitute in
 thoracoscopic surgery for idiopathic
 scoliosis.

								
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