Abstract
Adolescent idiopathic scoliosis (AIS) is a common spinal deformity usually treated with a surgical procedure comprising spinal fusion. Solid fusion after such surgery is important for the overall success of the procedure, where graft selection is also a significant factor. Allografts are as effective as autografts in the adolescent patient population; however, a major limitation is their high cost. The purpose of this investigation was to reassess the necessity for allografts when surgically treating AIS and compare the results between the use of only local autograft and a combination of autograft and allograft. Fifty-four patients with AIS with minimum follow-up of 2 years were assigned to 2 groups and analyzed. In 28 patients with a mean age of 14.2 years, local autografts harvested from the thoracic and lumbar vertebrae facet joints were used (autograft group). Over the top and bottom 3 segments of the fusion site, grafts were placed. Various combinations of autografts and allografts were applied over all fusion levels in 26 patients with a mean age of 15.1 years (allograft group). The mean follow-up period was 45.2 months in the autograft and 45.7 months in the allograft group. Mean 59.8 cc of freeze-dried crushed cancellous graft was used in the allograft group. The surgical outcomes were compared between the autograft and allograft groups. The mean of the major curvature angle is preoperatively measured as (59.9°, 63.9°); early postoperatively (11.5°, 13.8°) and (16.5°, 18.5°) at the final follow-up visit. Curve correction was calculated early postoperatively as 81.2%, 79.4%, 73.0%, and 72.3% at the last follow-up, respectively. All patients in both groups attained fusion. The major disadvantages in the use of allografts these days is the increased surgical cost. Our grafting technique thus demonstrated that allografts are not necessary as local autografts when used correctly would achieve fusion.