Radiographic and patient-based outcome analysis of different bone-grafting techniques in the surgical treatment of idiopathic scoliosis with a minimum 4-year follow-up: allograft versus autograft/allograft combination.

Abstract

Autograft and allograft have been equally successful in achieving arthrodesis, but whether there is any difference in their effect on patient outcome, especially early, has not been determined. To determine if autograft in addition to allograft is associated with decreased healing period pain, increased early function, or both. This is a retrospective comparative case series. A sample of 47 patients, 20 years or younger with adolescent idiopathic scoliosis treated by the same surgeon at the same institution using third-generation segmental spinal instrumentation and arthrodesis. Function and pain were quantified at periodic intervals using the Scoliosis Research Society (SRS) health-related quality of life (HRQoL) questionnaire. Clinical and radiographic follow-ups were completed. Freeze-dried corticocancellous allograft (AL) was used in 26 patients and allograft plus iliac crest autograft (AL-AU) in 21 patients. Radiographs and outcome measures, including SRS-24 or SRS-22 HRQoL questionnaires, were obtained preoperatively and at intervals with a 4-year follow-up available for 92% (25/26) of AL patients and 90% (19/21) of AL-AU patients. There were no differences between the AL and AL-AU groups' ages, curve patterns, and complications. Neither group had a major complication or pseudoarthrosis. There were no main curve size differences at any interval. Pain scores were similar at all intervals: AL/AL-AU preoperative, 4.1/4.0; early follow-up (<1 year), 3.7/4.1; midterm follow-up (1-2 years), 4.4/4.6; and late follow-up (>3 years), 4.1/4.0. Function scores were also similar at all intervals: AL/AL-AU preoperative, 4.7/4.6; early follow-up, 4.2/4.3; midterm follow-up, 4.9/4.9; and late follow-up, 4.5/4.4. The addition of autograft to allograft did not result in decreased pain or increased function at any time interval up to 4 years. We conclude that the addition of iliac crest autograft does not result in any advantage over freeze-dried allograft alone in the treatment of adolescent idiopathic scoliosis.