POSTERIOR SPINAL-FUSION SUPPLEMENTED WITH ONLY ALLOGRAFT BONE IN PARALYTIC SCOLIOSIS - DOES IT WORK

Study Design. The authors prospectively evaluated 40 patients with par alytic scoliosis treated from 1985 to 1990 with bilateral posterior se gmental instrumentation, facet fusions, local bone graft, and allograf t (mostly fresh frozen) bone supplementation only. Objectives. The aut hors report the fusion results for these patients, and any complicatio ns referable to the use of bank bone. Summary of Background Data. Acce ptable correction was obtained and maintained in the coronal and sagit tal planes for all but two patients (the third patient with a pseudart hrosis had not lost correction). The definite pseudarthrosis rate was 7.5%. One patient had a deep wound infection. Methods. The radiographs were graded as definitely solid, definitely a pseudarthrosis, or no i nstrumentation failure but difficult to visualize the whole fusion mas s. The patients selected for fusion without autogenous harvesting were especially frail and had reduced pulmonary and nutritional reserve. F ollow-up ranged from 2 + 2 years to 7 + 6 years, with an average of 3 + 9 years. Results. In the 40 surgical patients, there were three know n pseudarthroses. In 28 patients, there was a definite fusion. In the remaining nine patients (five with flaccid disease, four with spastic disease), the quality of their bone precluded definitive determination , but there was no obvious instrumentation failure or loss of correcti on. Conclusion. This study suggests that allograft bone graft is a sui table substitute for autogenous bone graft harvesting in select patien ts with paralysis in whom autogenous harvesting is not feasible.