Autogenous tibial strut grafts used in anterior spinal fusion for severe kyphosis and kyphoscoliosis

Study Design. A retrospective review was performed. Objective. To evaluate the results of autogenous tibial strut grafts for anterior fusions in children with severe kyphosis and kyphoscoliosis regarding maintenance of correction, clinical outcome, graft fractures, and donor-site morbidity. Summary and Background Data. Anterior strut grafts harvested from the iliac crest, rib, and fibula often are used to treat severe kyphosis and kyphoscoliosis. Several studies in the literature have observed graft failures, loss of correction, or donor-site morbidity when these grafts have been used. Autogenous tibial strut grafts provide some theoretical advantages with minimal donor-site morbidity. Methods. This review included 15 patients with severe kyphosis/kyphoscoliosis who underwent anterior spinal fusion with autogenous tibial strut grafts. Among these patients, 13 underwent staged or simultaneous posterior fusions, and 4 underwent cord decompression for myelopathy. An average of seven levels ( range, 3-13) were fused anteriorly. Preoperative, postoperative, and latest follow-up radiographs were evaluated for graft incorporation, fracture, hardware failure, and spinal alignment. Patients were examined at the latest follow-up visit, and charts were reviewed to assess neurologic status, back pain, alignment, complications, and donor-site problems. Results. All the patients were available for clinical examination. The mean follow-up period was 3.9 years ( range, 2-8 years). The mean kyphosis measured 89degrees before surgery, 62degrees after surgery, and 66degrees at the most recent follow-up assessment. In patients with kyphoscoliosis, the mean coronal curve measured 64degrees before surgery, 42degrees after surgery, and 46degrees at the latest follow-up assessment. Apparent fusion was observed in all cases with no graft fractures. One patient reported mild donor-site discomfort. Conclusions. Autogenous tibial strut grafts provide physical advantages over commonly used iliac crest, rib, and fibula grafts. The tibia provides dense cortical bone with ample length and mechanical strength, although the actual strength of each strut was not measured directly. In this study, adequate correction was maintained throughout an average follow-up period of 3.9 years, and solid fusion was obtained in all cases. The results indicate that this technique offers a reliable means of providing anterior support in the management of severe kyphosis with virtually no donor-site morbidity. Although the number of patients in this review was limited, the authors believe that anterior autogenous tibial struts are an excellent alternative for the treatment of severe kyphosis and kyphoscoliosis.