SYNTHETIC POROUS CERAMIC COMPARED WITH AUTOGRAFT IN SCOLIOSIS SURGERY- A PROSPECTIVE, RANDOMIZED STUDY OF 341 PATIENTS

We have evaluated the use of a synthetic porous ceramic (Triosite) as a substitute for bone graft in posterior spinal fusion for idiopathic scoliosis. In a prospective, randomised study 341 patients at five hos pitals in the UK and France were randomly allocated either to autograf t from the iliac crest or rib segments (171) or to receive Triosite bl ocks (170). All patients were assessed after operation and at 3, 6, 12 and 18 months. The two groups were similar with regard to all demogra phic and baseline variables, but the 184 treated in France (54%) had C otrel-Dubouset instrumentation and the 157 treated in the UK usually h ad Harrington-Luque implants. In the Triosite group the average Cobb a ngle of the upper curve was 56 degrees, corrected to 24 degrees (57%). At 18 months, the average was 26 degrees (3% loss). In the autograft group the average preoperative upper curve of 53 degrees was corrected to 21 degrees (60%). At 18 months the mean curve was 25 degrees (8% l oss). Pain levels after operation were similar in the two groups, bein g mild in most cases. In the Triosite group only three patients had pr oblems of wound healing, but in the autograft group, 14 patients had d elayed healing, infection or haematoma in the spinal wound. In additio n, 15 autograft patients had pain at the donor site at three months. S even had infections, two had haematoma and four had delayed healing. T he haematological and serum biochemistry results showed no abnormal tr ends and no significant differences between the groups. There were no adverse events related to the graft material and no evidence of allerg enicity. Our results suggest that Triosite synthetic porous ceramic is a safe and effective substitute for autograft in these patients. Hist ological findings on biopsy indicate that Triosite provides a favourab le scaffolding for the formation of new bone and is gradually incorpor ated into the fusion mass.