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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