Structural allograft versus autograft for instrumented atlantoaxial fusions in pediatric patients: radiological and clinical outcomes in a series of 32 patients.

Structural allograft versus autograft for instrumented atlantoaxial fusions in pediatric patients: radiological and clinical outcomes in a series of 32 patients.

World Neurosurg. 2017 Jun 14;:

Authors: Zhang YH, Shen L, Shao J, Chou D, Song J, Zhang J

Abstract
BACKGROUND: Allograft with wire techniques showed low fusion rate in pediatric atlantoaxial fusions (AAF) in early studies. Using allograft in pediatric AAF with screw/rod constructs has not been reported. Thus, we compared the fusion rate and clinical outcomes in pediatric patients who underwent atlantoaxial fusions (AAF) with screw/rod constructs using either a structural autograft or allograft.
METHODS: Pediatric patients (aged ≤12 years) who underwent AAF between 2007 and 2015 were retrospectively evaluated. Patients were divided into two groups (allograft or autograft). Clinical and radiographic results were collected from hospital records and compared.
RESULTS: A total of 32 patients were included (18 allograft, 14 autograft). There were no significant group differences in age, sex, weight, diagnosis, or duration of follow-up. A similar fusion rate was achieved (allograft: 94%, 17/18; autograft: 100%, 14/14); however, the average fusion time was 3 months longer in the allograft group. Blood loss was significantly lower in the allograft group (68±8.5 ml) than in the autograft group (116±12.5 ml). Operating time and length of hospitalization were slightly (non-significantly) shorter for the allograft group. A significantly higher overall incidence of surgery-related complications was seen in the autograft group, including a 16.7% (2/14) rate of donor site-related complications.
CONCLUSIONS: The use of allograft for AAF was safe and efficacious when combined with rigid screw/rod constructs in pediatric patients, with a similar fusion rate to autografts and an acceptable complication rate. Furthermore, blood loss was less when using allograft and donor-site morbidity was eliminated; however, the fusion time was increased.

PMID: 28624564 [PubMed - as supplied by publisher]

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