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Bone graft in posterior spine fusion for adolescent idiopathic scoliosis: a meta‐analysis
Author(s) -
Kirzner Nathan,
Hilliard Luke,
Martin Catherine,
Quan Gerald,
Liew Susan,
Humadi Ali
Publication year - 2018
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.14551
Subject(s) - medicine , iliac crest , spinal fusion , meta analysis , confidence interval , scoliosis , cochrane library , idiopathic scoliosis , surgery , strictly standardized mean difference , blood loss
Backgrounds The aim of this study was to systematically analyse and perform a meta‐analysis on the current available literature comparing the fusion rates and complications associated with use of autograft, allograft and bone substitutes to supplement posterior spinal fusion for adolescent idiopathic scoliosis (AIS). Methods The electronic databases including Embase, PubMed, Medline, Cinahl and Cochrane Library were searched to identify relevant studies. A total of 12 studies with 2389 patients were included for meta‐analysis. The primary outcome was fusion rate, while the secondary outcomes included blood loss, operation time, infection rates and post‐operative pain. Results The current meta‐analysis found no difference in fusion rates between groups with an overall fusion rate of 100% (95% confidence interval (CI) 0.99–1.00; P < 0.05). Total estimated blood loss was significantly higher in the iliac crest bone graft (ICBG) group compared with control group (1018 versus 861 mL; P < 0.01). In addition, the mean operative time was significantly higher in the ICBG group (259 versus 237 min; P < 0.001). The ICBG group also had increased post‐operative pain issues compared with the control group (26 versus 9%; P < 0.001). There was no significant difference in terms of post‐operative wound infection between groups with an overall infection rate of 1% (95% CI 0.0–0.02; P = 0.06). Conclusion ICBG confers no advantage over the other graft options in achieving fusion in AIS surgery. Furthermore, crest harvesting was associated with significant increases in blood loss, operative time and post‐operative pain issues. Therefore, allograft and bone substitutes are attractive alternatives to autogenous grafting during posterior fusion in AIS.