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Volumetric Changes of Iliac Crest Autografts Used to Reconstruct the Anterior Column in Thoracolumbar Fractures: A Follow-up Using CT Scans

Morrison, Robert H., MD; Thierolf, Antje, MD; Weckbach, Arnulf, MD, PhD

doi: 10.1097/BRS.0b013e31815cdeae

Study Design. Patients with a thoracolumbar injury had a reconstruction of the anterior column using an tricortical iliac crest autograft. The volume and the length of the autograft were measured after 9 and 21 months using computed tomography.

Objective. To assess the volumetric change of an iliac crest autograft used to perform a reconstruction of the anterior column.

Summary of Background Data. Iliac crest autografts are commonly used to reconstruct the anterior column following spinal fractures. However, very few reports have actually looked into the changes within the autograft following surgery. To our knowledge, no study has actually measured the loss of volume and length taking place within the graft using a CT scan.

Methods. From January 1995 through May 2000, 27 patients of the 155 operated patients treated with a posterior-anterior stabilization of a fracture within the thoracic and lumbar spine were included in this study. Selection criteria were a postoperative CT and the reconstruction of the anterior column using an iliac crest autograft. A CT scan was performed before instrumentation removal and 1 year after instrumentation removal. These scans were used to evaluate the volume and length of the graft.

Results. There is a significant loss of graft volume (about 40%), half of which was not seen until after instrumentation removal. There is a correlation between the volumetric loss and the initial volume of the graft. The loss in length (24%) results in a correctional loss of the superior-inferior endplate angle totalling 12°. All grafts showed good contact to the adjoining vertebrae with no case of a pseudarthrosis.

Conclusion. The results show that more than a third of the initial graft volume is absorbed during the consolidation process. The loss was greater, the larger the volume of the initial graft was. The efficiency, however, was not dependent on the initial graft size.

Patients with fractures of the thoracolumbar region of the spine received a posterior fixation and an anterior reconstruction using a iliac crest autograft. In the current study, we used CT scans to evaluate the volume and length of the graft. After nearly 2 years, the graft had subsided by 40% of its volume and lost 24% of its initial length.

From University Clinic Wuerzburg, Wuerzburg, Germany.

Acknowledgment date: May 1, 2007. Revision date: June 4, 2007. Acceptance date: June 6, 2007.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Robert H. Morrison, MD, University Clinic Wuerzburg, Department of Trauma Surgery, Oberdürrbacher Str. 6, 97080 Wuerzburg, Germany; E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.