Bone grafting options in children

Abstract

Study design: Retrospective review of the literature.

Objective: To review the current literature as well as recent trends in bone grafting techniques available for children.

Summary of background data: The currently accepted gold standard in bone grafting for adolescent idiopathic scoliosis (AIS) is autogenous iliac crest. Due to questions concerning complications such as donor site pain, other options have been explored, including various allograft sources, demineralized bone matrix, and bone morphogenetic protein.

Methods: A review of the current medical literature was completed and additional case examples are presented.

Results: A review of the literature reveals that up to 31% of patients have persistent pain at 2 years post surgery when autogenous iliac crest bone graft is harvested. Allograft supplementation of local autograft has been demonstrated in the literature to be as effective as autogenous iliac crest bone grafting in contributing to a successful posterior spinal fusion in patients with AIS. Modern demineralized bone matrix formulations have been found in both animal models as well as in a recent retrospective clinical review to contribute to a successful posterior spinal fusion in AIS. Bone morphogenetic protein has been shown to contribute to a successful posterior spinal fusion in complex pediatric spinal deformity patients. At 2 years follow-up, patients who underwent a posterior instrumented spinal fusion that was not augmented with any bone graft appear to have successful spinal fusions.

Conclusion: Although autogenous iliac bone graft remains the benchmark to which bone grafting materials are compared, other options including the placement of no bone graft at all provides similar fusion rates in patients with AIS.