A synthetic porous ceramic as a bone graft substitute in the surgical management of scoliosis - A prospective, randomized study

Study Design. A prospective randomized study. Objectives. To assess the clinical and radiologic performances of a synthet ic ceramic as a bone graft substitute in scoliosis surgery. Summary of Background Data. Surgery on the skeleton frequently requires har vesting of autogenous bone grafts from the pelvis, but this procedure often is complicated by problems. Methods. fifty-eight patients with idiopathic scoliosis, ages 13 to 25 year s, were treated by posterior correction and arthrodesis using Cotrel-Dubous set instrumentation. Posterior spinal fusion was performed using local bone grafts combined with autogenous iliac bone grafts in 30 patients, and comb ined with porous biphasic calcium phosphate ceramic blocks comprising hydro xyapatite and tricalcium phosphate in another 28 patients. The patients wer e observed for a minimum of 24 months after surgery, with a mean postoperat ive observation time of 48 months. The results were assessed clinically and radiographically. Results. Patients in the ceramic group had a lower average blood loss than those in the iliac graft group. They also were free from postoperative loca l complications in the iliac region, which were experienced by a significan tly high proportion of patients belonging to the iliac graft group. Radiogr aphy demonstrated successful incorporation of the ceramic blocks within 12 months. The correction of the deformity was maintained similarly and satisf actorily in both groups. Conclusions. These results justify and favor the use of calcium phosphate c eramics as bone graft substitutes for instrumented posterior spinal fusion in teenagers and young adults. Potentially hazardous harvesting of pelvic b one is no longer necessary for such operations.