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Scientific Articles   |    
The Effect of Iliac Crest Autograft on the Outcome of Fusion in the Setting of Degenerative SpondylolisthesisA Subgroup Analysis of the Spine Patient Outcomes Research Trial (SPORT)
Kristen Radcliff, MD1; Raymond Hwang, MD, MEng, MBA2; Alan Hilibrand, MD1; Harvey E. Smith, MD3; Jordan Gruskay, BS1; Jon D. Lurie, MD, MS4; Wenyan Zhao, PhD4; Todd Albert, MD1; James Weinstein, DO, MS4
1 Rothman Institute, Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA 19107. E-mail address for K. Radcliff: kris.radcliff@rothmaninstitute.com
2 Midwest Orthopaedic Institute, 2111 Midlands Court, Sycamore, IL 60178
3 New England Orthopaedic and Spine Surgery, 830 Boylston Street, Suite 211, Chestnut Hill, MA 02467
4 Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756
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Investigation performed at the Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Orthopaedic Surgery, Tufts University School of Medicine, and New England Baptist Hospital, Boston, Massachusetts; and Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire

This article was chosen to appear electronically on August 8, 2012, in advance of publication in a regularly scheduled issue.



Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, one or more of the authors has had another relationship, or has engaged in another activity, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Sep 19;94(18):1685-1692. doi: 10.2106/JBJS.K.00952
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Abstract

Background: 

There is considerable controversy about the long-term morbidity associated with the use of posterior autologous iliac crest bone graft for lumbar spine fusion procedures compared with the use of bone-graft substitutes. The hypothesis of this study was that there is no long-term difference in outcome for patients who had posterior lumbar fusion with or without iliac crest autograft.

Methods: 

The study population includes patients enrolled in the degenerative spondylolisthesis cohort of the Spine Patient Outcomes Research Trial who underwent lumbar spinal fusion. Patients were divided according to whether they had or had not received posterior autologous iliac crest bone graft.

Results: 

There were 108 patients who had fusion with iliac crest autograft and 246 who had fusion without iliac crest autograft. There were no baseline differences between groups in demographic characteristics, comorbidities, or baseline clinical scores. At baseline, the group that received iliac crest bone graft had an increased percentage of patients who had multilevel fusions (32% versus 21%; p = 0.033) and L5-S1 surgery (37% versus 26%; p = 0.031) compared with the group without iliac crest autograft. Operative time was higher in the iliac crest bone-graft group (233.4 versus 200.9 minutes; p < 0.001), and there was a trend toward increased blood loss (686.9 versus 582.3; p = 0.057). There were no significant differences in postoperative complications, including infection or reoperation rates, between the groups. On the basis of the numbers available, no significant differences were detected between the groups treated with or without iliac crest bone graft with regard to the scores on Short Form-36, Oswestry Disability Index, Stenosis Bothersomeness Index, and Low Back Pain Bothersomeness Scale or the percent of patient satisfaction with symptoms averaged over the study period.

Conclusions: 

The outcome scores associated with the use of posterior iliac crest bone graft for lumbar spinal fusion were not significantly lower than those after fusion without iliac crest autograft. Conversely, iliac crest bone-grafting was not associated with an increase in the complication rates or rates of reoperation. On the basis of these results, surgeons may choose to use iliac crest bone graft on a case-by-case basis for lumbar spinal fusion.

Level of Evidence: 

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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