¿Es el autoinjerto del campo quirúrgico suficiente para la obtención de una buena artrodesis en paciente con escoliosis idiopática del adolescente? / Is local bone graft sufficient to maintain the surgical correction in adolescent idiopathic scoliosis curves?

Objetivo. El objetivo de este trabajo es determinar si los resultados clínicos y radiológicos obtenidos en cuanto a corrección a largo plazo se mantienen de forma similar usando injerto de cresta ilíaca ( CI ) o solo el hueso local (HL) en los pacientes intervenidos con escoliosis idiopática del adolescente. Pacientes y métodos. Se efectuó un estudio retrospectivo de cohortes homogéneas de 73 pacientes (CI n = 37 y HL n = 36) con escoliosis idiopática intervenidos mediante artrodesis por vía posterior con un seguimiento medio de 126 meses en el grupo CI y 66 meses en el grupo HL. Se compararon los resultados en cuanto a corrección quirúrgica y pérdida de la misma según las mediciones de los ángulos de Cobb en telerradiografías antero-posteriores y laterales preoperatorias, postoperatorias y finales, y se valoraron los resultados clínicos mediante el cuestionario SRS-22. Resultados. En el grupo HL la corrección postoperatoria resultó significativamente mayor 61 ± 15% vs. 51 ± 14% del grupo CI (p < 0,004). Durante la evolución el grupo CI presentó una pérdida de corrección media de 4,5 ± 7,3° respecto a los 8,5 ± 6,9° del grupo HL, (p = 0,02). La corrección final obtenida se iguala entre ambos grupos, 42 ± 18% vs. 46 ± 17% (p = 0,3). No se observa correlación clínica en la muestra respecto a los resultados del SRS-22. Conclusiones. Los pacientes intervenidos en los que se emplea injerto de CI tienen una pérdida de corrección inferior a los pacientes en los que se emplea injerto de HL aunque no parece existir correlación clínica de esta pérdida de corrección (AU)

Objective: The purpose of this study was to compare postoperative clinical and radiological results in adolescent idiopathic scoliosis curves treated by posterior arthrodesis using autogenous bone graft from iliac crest (CI) versus only local autograft bone (HL). Patients and methods: A retrospective matched cohort study was conducted on 73 patients (CI n=37 and HL n=36) diagnosed with adolescent idiopathic scoliosis and treated surgically by posterior arthrodesis. The mean post-operative follow-up was 126 months in the CI group vs. 66 months in the HL group. The radiographic data collected consisted of preoperative, postoperative, and final follow-up antero-posterior and lateral full-length radiographs. Loss of correction and quality of arthrodesis were evaluated by comparing the scores obtained from the Spanish version of the SRS-22 questionnaire. Results: There were significant differences in the post-operative results as regards the correction of the Cobb angle of the main curve (HL 61 ± 15% vs. CI 51 ± 14%, P<.004), however a greater loss of correction was found in the local bone group (CI 4.5 ± 7.3◦ vs. HL 8.5 ± 6.3◦, P=.02). There were no significant differences as regards the correction of the Cobb angle of the main curve at the end of follow-up. There were no clinical differences between the two groups in the SRS-22 scores. Conclusion: At 5 years of follow-up, there was a statistically significant greater loss of radiographic correction at the end of final follow-up in the local bone graft group. However clinical differences were not observed as regards the SRS-22 scores (AU)

[Is local bone graft sufficient to maintain the surgical correction in adolescent idiopathic scoliosis curves?]. / ¿Es el autoinjerto del campo quirúrgico suficiente para la obtención de una buena artrodesis en paciente con escoliosis idiopática del adolescente?

OBJECTIVE: The purpose of this study was to compare postoperative clinical and radiological results in adolescent idiopathic scoliosis curves treated by posterior arthrodesis using autogenous bone graft from iliac crest (CI) versus only local autograft bone (HL). PATIENTS AND METHODS: A retrospective matched cohort study was conducted on 73 patients (CI n=37 and HL n=36) diagnosed with adolescent idiopathic scoliosis and treated surgically by posterior arthrodesis. The mean post-operative follow-up was 126 months in the CI group vs. 66 months in the HL group. The radiographic data collected consisted of preoperative, postoperative, and final follow-up antero-posterior and lateral full-length radiographs. Loss of correction and quality of arthrodesis were evaluated by comparing the scores obtained from the Spanish version of the SRS-22 questionnaire. RESULTS: There were significant differences in the post-operative results as regards the correction of the Cobb angle of the main curve (HL 61 ± 15% vs. CI 51 ± 14%, P<.004), however a greater loss of correction was found in the local bone group (CI 4.5 ± 7.3° vs. HL 8.5 ± 6.3°, P=.02). There were no significant differences as regards the correction of the Cobb angle of the main curve at the end of follow-up. There were no clinical differences between the two groups in the SRS-22 scores. CONCLUSION: At 5 years of follow-up, there was a statistically significant greater loss of radiographic correction at the end of final follow-up in the local bone graft group. However clinical differences were not observed as regards the SRS-22 scores.