Pseudarthrosis after spinal fusion for scoliosis. A comparison of autogeneic and allogeneic bone grafts.

This study was undertaken to compare the incidence of pseudarthrosis in fusions supplemented with autogeneic and frozen allogeneic grafts. The records of 208 patients with adolescent idiopathic scoliosis who were treated by posterior fusion and Harrington instrumentation were studied. The fusion was supplemented by an autogeneic iliac bone graft in 114 patients and by an allogeneic bank bone graft in 94 patients. The fusion mass was explored in all patients with suspected pseudarthrosis; therefore, all pseudarthroses reported in this series were proved by surgical exploration. Pseudarthrosis developed in five patients (4.4%) receiving an autogeneic graft and in five patients (5.3%) receiving an allogeneic graft. The incidence of pseudarthrosis was not significantly different at the 95% level of certainty. Average blood loss and operative time were determined for all patients. The decreases in average blood loss and operative time in those patients receiving allogeneic grafts were significant (p less than .01). Thus, based on the incidence of pseudarthrosis, allogeneic frozen bank-stored bone is an attractive alternative to autogeneic iliac bone for fusion supplementation in the treatment of scoliosis. Total operative time and blood loss can be decreased, and possible complications associated with a donor site can be avoided.