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. 2011 May;2(2):35-40.
doi: 10.1055/s-0030-1267103.

Lumbar posterolateral fusion with local bone graft plus bone extender compared with iliac crest bone graft: a systematic review

Robert A McGuire  1 , Leslie E Pilcher, Joseph R Dettori
Affiliations

Lumbar posterolateral fusion with local bone graft plus bone extender compared with iliac crest bone graft: a systematic review

Robert A McGuire et al. Evid Based Spine Care J. 2011 May.

Abstract

Study design: Systematic review. Study rationale and context: Bone graft from the iliac crest has been the gold standard in posterolateral spinal fusion procedures, but is associated with chronic pain at the harvest site. Bone graft harvested locally from the spine and combined with extenders may decrease the morbidity associated with iliac graft harvest, but questions remain on the success of this technique to achieve bone union.

Objectives: Compare the fusion rate, functional outcomes, and safety of local bone graft plus bone extender compared with iliac crest bone graft in posterolateral spinal fusion procedures.

Methods: A systematic review of the literature was undertaken for articles published through January 2011. Pubmed, Cochrane, National Guideline Clearinghouse Databases, and bibliographies of key articles were searched. Two independent reviewers studied the articles. Inclusion and exclusion criteria were set and each article was subject to a predefined quality-rating scheme.

Results: We identified three articles meeting our inclusion criteria. Fusion rates were high across studies, with no significant differences between treatment groups in fusion, functional outcomes, or quality of life. There were two deep infections (5.3%) in one study among patients receiving local bone graft plus extender.

Conclusion: Local bone graft plus bone extender has similar fusion rates, functional outcomes, and patient quality-of-life scores as iliac crest bone graft in posterolateral spinal fusion procedures. Additional randomized trials with standardized methods of measuring fusion and functional outcomes are needed.

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Conflict of interest statement

This systematic review was funded by AOSpine.

Figures

Fig. 1
Fig. 1
Results of literature search.
Fig. 2
Fig. 2
Fusion rates of bone extender plus local bone graft vs iliac bone crest graft.
Fig. 3
Fig. 3
Functional and QoL outcomes (A) mean score improvement at follow-up (F/U) vs baseline; (B) mean percentage improvement at follow-up vs baseline. Error bars represent 95% confidence intervals.
Fig. 4
Fig. 4
AP x-ray reveals excellent bone growth and stable intertransverse fusion at the L4/5 level.
Fig. 5
Fig. 5
Lateral x-ray reveals excellent bone mass in the posterolateral space between L4/5.
See this image and copyright information in PMC

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Editorial Staff Perspective
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