Introduction: Spinal fusion surgery is used to treat a variety of spinal conditions. Many techniques are currently employed to achieve the synonymous goal of fusion. One such method is the use of bone grafts for osteogenesis, which may be autogenic from the operative site, or allogenic from cadaveric bone. Although similar in fusion rates, allograft material was instituted due to peri- and post-operative complications from autograft harvesting in the 1950s. Allograft is readily available, easy to store, and historically demonstrated decreased donor site morbidity and post-operative complications. However, much heterogeneity exists within the literature concerning which graft material is superior secondary to variation in the anatomical site of fusion, number of levels fused and surgical approach. Our study will focus on patient outcomes by comparing autograft and allograft materials in single and multilevel lumbar fusion.
Methods: A retrospective chart analysis was conducted to analyze all patients who underwent transforaminal lumbar interbody fusion (TLIF) operation with the senior author from 2013-2016. Eighty-nine patients were identified who met the inclusion criteria, and divided based on type of graft used, and the number of levels fused.
Results: Statistics showed that only the estimated blood loss, and operative time were significantly higher in multi-level fusion operation, independent of graft type. Patient demographics, post-operative hospital stay, pain scores and fusion rates did not differ significantly between groups. The increase in blood loss and surgical time in multilevel disease likely owes to the inherent involvement of multi-level fusion. All patients in our study showed radiographic evidence of fusion at 1 year.
Conclusions: There exist no significant differences in long-term patient outcomes between the use of allograft and autograft based on the number of levels fused intraoperatively in the lumbar spine. The historic hesitancy to use autograft should no longer influence operative planning in specific surgical settings.
Patient Care: Operative planning for multi-level spinal fusions may now be based on patient-specific needs rather than hesitancy to exclude autograft materials.
Learning Objectives: By the conclusion of this session, participants should be able to: 1)Understand the use of bone graft materials in spinal fusion procedures, 2)Understand the advantages and disadvantages of autograft and allograft bone grafts, 3)Discuss the difference in outcomes between single and multi-level use of bone graft materials.