Abstract
Purpose
To assess the effect of demineralized cortical fibers (DCF) on postoperative pseudarthrosis requiring revision surgery in patients undergoing pedicle subtraction osteotomy (PSO) for adult spinal deformity (ASD).
Methods
The use of DCF was introduced across all procedures in 2017 and subsequent patients undergoing PSO surgery were prospectively and consecutively registered. Following sample-size estimation, a retrospective cohort was also registered undergoing the same procedure immediately prior to the implementation of DCF. The non-DCF group underwent surgery with ABG. Minimum follow-up was 2 years in both groups. The main outcome was postoperative pseudarthrosis, either CT-verified or verified intraoperatively during revision surgery due to rod breakage and assessed using Kaplan–Meier survival analyses.
Results
A total of 48 patients were included in the DCF group and 76 in the non-DCF group. The DCF group had more frequently undergone previous spine surgery (60% vs 36%) and had shorter follow-up (32 ± 2 vs 40 ± 7 months). Pseudarthrosis occurred in 7 (15%) patients in the DCF group and 31 (41%) in the non-DCF group, corresponding to a relative risk increase of 2.6 (95%CI 1.3–2.4, P < 0.01). 1-KM survival analyses, taking time to event into account and thus the difference in follow-up, also showed increased pseudarthrosis in the non-DCF group (log-rank P = 0.022). Similarly, multivariate logistic regression adjusted for age, instrumented levels and sacral fusion was also with significantly increased odds of pseudarthrosis in the non-DCF group (OR: 4.3, 95%CI: 1.7–11.3, P < 0.01).
Conclusion
We found considerable and significant reductions in pseudarthrosis following PSO surgery with DCF compared to non-DCF.
Level of evidence
III.
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TJB: Substantial contributions to the conception or design of the work. Substantial contributions to the acquisition, analysis and interpretation of data. Revising the work critically for important intellectual content. Final approval of the version to be published. Agree to be accountable for all aspects of the work. LVH: Substantial contributions to the conception or design of the work. Revising the work critically for important intellectual content. Final approval of the version to be published. Agree to be accountable for all aspects of the work. BD: Substantial contributions to the conception or design of the work. Revising the work critically for important intellectual content. Final approval of the version to be published. Agree to be accountable for all aspects of the work. MG: Substantial contributions to the conception or design of the work. Revising the work critically for important intellectual content. Final approval of the version to be published. Agree to be accountable for all aspects of the work.
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Bari, T.J., Hansen, L.V., Dahl, B. et al. Use of demineralized cortical fibers is associated with reduced risk of pseudarthrosis after pedicle subtraction osteotomy for adult spinal deformity. Spine Deform 10, 657–667 (2022). https://doi.org/10.1007/s43390-021-00444-x
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DOI: https://doi.org/10.1007/s43390-021-00444-x