Journal of Spine

Bone Graft Wrapping with Cellulose Polymer Sheet in Posterior Spinal Fusion. A Technical Note

Abstract

Gelalis D. Ioannis, Karageorgos Athanasios, Politis N. Aggelos, Matzaroglou Charalambos, Abuhemoud Q. Khaled, Batzalexis A. Nikolaos and Beris E. Alexandros

Background: Spinal fusion is one of most frequent employed procedures for treating various spinal morbidities. Pseudarthrosis remains a significant complication despite the use of hardware for mechanical stability. The type and proper placement of the bone graft have a fundamental role in achieving solid union. The ideal bone graft material should provide osteogenicity, osteoinductivity and osteoconductivity, an optimal biological reaction and no risk of transmission of diseases.

Methods: We describe a new technique of bone grafting in two patients who suffered from spinal stenosis. Local bone graft which obtained during decompression of the spine was mixed with bone marrow harvested from the posterior iliac crest. The mixture was wrapped in surgicel (Ethicon, Johnson & Johnson Medical Ltd, Somerville, NJ, USA) and given a cylindrical shape. Finally, the handmade cylinders were placed laterally to the rod of the instrumentation, onto the decorticated transverse processes.

Results: The patients were followed radiographically every three months. The x-rays verified proper placement of the graft onto the transverse processes in both patients. Solid fusion was reported in both sides of the first patient at three months and at six months for the second. At one year postoperatively, fusion status was still graded solid.

Conclusion: The aforementioned technique uses the advantages of a bone auto graft which has been enhanced by bone marrow components, avoiding donor site morbidity. Using surgicel (Ethicon, Johnson & Johnson Medical Ltd, Somerville, NJ, USA) we can adapt the graft to the desired size and shape and finally place it with accuracy onto the decorticated transverse processes. This is a promising technique concerning solid fusion and complications; however, it is a pilot study and needs more time and patients to obtain safe results.