Evaluation of synthetic vs. autologous bony graft fusion in acute thoraco-lumbar burst fractures

In present need to fuse bony elements of the spine. Autologous bone from the iliac crest or rib is often used for these purposes but harvesting this bone necessitates the removal of the graft from another site. Moreover, grafts of autogenic bone may be resorbed to a significant degree with time. These shortcomings have provided the impetus for the use of bone substitutes in spinal surgery. We aimed to evaluate the efficacy of reinforcing short-segment pedicle screw fixation with postero-lateral fusion with synthetic bone substitute in thoraco-lumbar burst fracture.We enrolled 48 patients with thoraco-lumbar burst fractures for treatment with short-segment pedicle screw fixation. Group A [n = 23] were reinforced with postero-lateral fusion with synthetic bone substitute during surgery. Group B [n = 25] underwent pedicle screw fixation and postero-lateral fusion with cancellous iliac bone graft. The radiographic and clinical results were compared between the two groups. In both groups, no significant difference in terms of solid bony fusion or clinical symptoms or radiological evidences of spinal instability. Patients in group A had short duration of surgery, less blood loss and short hospital stay as compared to patients in group B. The Frankel performance scale scores increased by nearly one in both groups. Group A had more patients with no pain, minimal or occasional pain [grade P1 or P2] than group B [86% [n = 20] vs. 44% [n = 11]]. One patient [4.3%] of group A and 6 patients [24%] of group B had severe and constant pain [grade P4, P5] [P < 0.001, two tailed Fischer's exact test]. The synthetic bone substitutes are effective graft materials in postero-lateral thoraco-lumbar spine fusion. They are available in unlimited quantities and associated with no donor site morbidity

Posterior cruciate ligament; magnetic resonance imaging

Magnetic Resonance imaging of posterior cruciate ligament [PCL] was done in sagittal and coronal views. Axial images were obtained as the need arises. Seventy two patients without any prior history of systemic and local illness were included in the study. The examination was conducted in those with acute history of trauma. Study was conducted at Lahore Medical Imaging [PVT] Limited, Lahore. Ten patients were volunteers as control to study the normal anatomy of posterior cruciate ligament [PCL] as seen on MRI. We found that MRI can be valuable for evaluating the acutely injured knee when operative repair for the PCL is being considered. This is also invaluable as the clinical and arthroscopic assessment of PCL injury can be difficult in acute injury