Histology of a fusion mass augmented with demineralized bone matrix for congenital scoliosis

Abstract

The pseudarthrosis rate after a posterior spinal fusion for congenital scoliosis and kyphoscoliosis is high, between 9.1 and 46.1%. Autogenous iliac crest bone graft is the current gold standard graft material, but is associated with complications that include donor site pain and infection. Demineralized bone matrix (DBM) may be a cost effective, safe, and clinically effective alternative bone graft material. The medical records of a single patient with the diagnosis of congenital scoliosis who had undergone a posterior spinal fusion were reviewed under an institutional review board approved protocol. At 11 months after posterior spinal fusion, bone biopsies were obtained upon routine planned exploration of the spinal fusion site. These samples were sectioned and reviewed by an independent pathologist to assess for bone maturity and the presence of residual allograft bone graft material. The histological specimens that were obtained from the patient showed mature bone with no residual graft material evident in any of the samples. In conclusion, in this particular case, the DBM was fully incorporated into the fusion mass. Although a large clinical trial would be necessary to make generalized conclusions about the use of DBM in the congenital scoliosis population, this histological analysis adds evidence that DBM is incorporated and may aid in obtaining a solid spinal fusion in this difficult population.