Osseous integration of autogenous bone grafts following combined dorso-ventral instrumentation of unstable thoracolumbar spine fractures

Objective. It is widely believed that combined dorso-ventral stabilization provides superior mechanic stability in the operative treatment of thoracolumbar spine fractures. Currently there are no data available reflecting the fusion rates in trauma patients following the combined procedure. Aim of this investigation was to study the fusion rates following dorso-ventral stabilization of thoracolumbar spine fractures and the rates of local complications at the donor site. Methods. In order to assess fusion and complication rates 30 patients with unstable fractures of the thoracolumbar spine were selected from a consecutive series and investigated in a prospective study. After posterior stabilization with a fixateur interne (USS, Synthes) anterior arthrodesis was performed subsequently by autogenous iliac bone grafting in combination with an osteosynthesis (MACS,Aesculap;VentroFix,Synthes). The osseous integration of the autogenous transplants was measured by CT-scan 12 +/- 2.4 months after surgery. Results. The evaluation of the radiographic and CT data revealed a fusion rate of 77% (23/30) one year after surgery. These findings were accompanied by minor complications at the donor site in 37% (11/30). Conclusion. Our experiences with autogenous spine grafting gave evidence that a reliable osseus integration can not be expected in all of the cases. Furthermore one has to consider a high rate of local complications. Therefore alternative procedures such as the use of cages will be of increasing influence in the surgical treatment of thoracolumbar spine fractures.