PubMed · 15409577
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V COHEN. 1949. [Bone transplants].. https://pubmed.ncbi.nlm.nih.gov/15409577/
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Although it was originally developed to address degenerative problems, including disc herniations and cervical spondylotic myelopathy in the adult population, the anterior approach to the subaxial spine has proven to be useful for select indications in the pediatric population. The authors review indications for surgery, bone grafting, and instrumentation as they pertain to children.
Treatment of central longitudinal deficiencies is well defined, with different techniques established for the classical clefts. However, none of these techniques is easily applied to the treatment of very deep clefts accompanied by a significant divergence of the metacarpal bones. In such cases, the results of current techniques are disappointing. We propose a new technique of "Translocation in the Radial direction of the Ulnar Finger(s)" (TRUF) by intra-carpal osteotomy. The results are illustrated in three clinical cases. The TRUF operation allowed closing of the cleft, alignment of the metacarpal bones and preservation of carpometacarpal mobility. When necessary, a metacarpal synostosis may be treated at the same procedure.
STUDY DESIGN: A retrospective review. OBJECTIVE: To review the initial experience using a trephine bone harvesting system from the local lumbar spine for use in anterior interbody fusions, analyzing fusion rates and complications. SUMMARY OF BACKGROUND DATA: Historically, autogenous bone for lumbar spine fusions has been procured from the iliac crest. No data exist regarding the use of a trephine bone harvesting system for obtaining cancellous bone locally from the lumbar spine for use in anterior interbody fusions. In this technique, the donor site is replaced with a corticocancellous humeral dowel. METHODS: A total of 36 patients who underwent anterior lumbar interbody fusion were retrospectively reviewed. There were 56 interbody fusions performed using 36 trephine donor sites. Twenty individuals had the bone divided between 2 fusion levels, placed within allograft femoral rings, and 16 had the bone applied to 1 fusion level. Radiographs were analyzed for complications associated with the fibular dowel and time to interbody fusion. RESULTS: By 6 months, 35 of 36 (97%) of the corticocancellous fibular dowels had incorporated. Two dowels migrated 3 mm, each without sequelae. Of 56 of interbody spaces, 50 (89%) were fused. Two eventually fused at 9 and 11 months, and 4 (7%) failed to unite by 15 months. CONCLUSION: Harvesting cancellous autograft anteriorly from the lumbar spine using a trephine technique appears to be safe and reliable, with satisfactory fusion rates. Iliac crest graft harvesting with its attendant morbidity is avoided.