Research Roundup: Iliac Crest Bone Grafts Can Lengthen Hospital Stay

The following is a roundup of three recently published medical studies that provide new insights into spinal procedures and patient outcomes:

Unilateral, Bilateral Kyphoplasty Comparable for Osteoporotic Vertebral Compression Fractures
Orthopedics

Unilateral balloon kyphoplasty was found to produce outcomes comparable to those of bilateral balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures, according to study results.

Hua Chen, M.D., and colleagues conducted a meta-analysis of 14 randomized, controlled studies comparing the unilateral and bilateral approach to kyphoplasty for the treatment of osteoporotic vertebral compression fractures. A total of 876 patients were included, with a mean follow-up of 17.5 months.

The researchers found there were no significant differences between the two approaches in visual analog score (VAS) pain scores for up to two years, Oswestry Disability Index pain score for up to one year, anterior and middle vertebral height, or kyphotic angle.

However, use of the unilateral approach resulted in less cement needed for an injection, shorter operation time and a lower risk of cement leakage than with the bilateral approach, according to the researchers.

Because unilateral kyphoplasty was found to result in pain relief, vertebral height and kyphotic angle restoration comparable to bilateral kyphoplasty, the researchers concluded that it should be considered an effective treatment option.

Iliac Crest Bone Graft for Spinal Fusion Increased Short-Term Adverse Events
Spine

Use of iliac crest bone grafts for spinal fusions led to increased length of hospital stay, increased postoperative blood transfusions and extended operative times, according to recent study findings.

Researchers conducted a retrospective study using the American College of Surgeons National Surgical Quality Improvement Project 2010-2012 database, analyzing data for 13,927 patients who underwent spinal fusion. Among these cases, 820 included the use of iliac crest bone grafts (ICBGs).

The researchers reviewed demographics, comorbidities, surgical data and both hospital and 30-day follow-up outcomes, which included adverse events, length of hospital stays and rates of readmission.

Patients in whom ICBGs were used were more likely to have a postoperative blood transfusion compared with patients in whom the grafts were not used. Additionally, patients in the ICBG cohort had longer operative times and extended lengths of hospital stay, according to the researchers.

Upon completing multivariate analyses in which the researchers controlled for comorbidities, demographics and approach, the researchers confirmed that use of ICBGs was significantly associated with postoperative blood transfusion, extended operative time and increased length of stay.

Other outcomes such as infection, return to the operating room and deep vein thrombosis were not changed by use ICBG, according to the researchers.

Cervical Total Disc Replacement Maintains Segmental Motion After Posterior Decompression
Spine

For same-segment disease, a unilateral foraminotomy can be performed safely, according to researchers.

Michael J.Brody, M.D., and colleagues tested eight human cadaveric cervical spines to determine the kinematics of a cervical total disc replacement (TDR) both before and after posterior cervical decompression. The C3–C7 were tested in flexion-extension, lateral bending and axial rotation while intact, after C5–C6 total disc replacement, C5–C6 unilateral foraminotomy, C5–C6 bilateral foraminotomies, and after C5 laminectomy in combination with the bilateral foraminotomies. The researchers obtained moment vs. angular motion curves for each testing step and analyzed load-displacement data to determine the range of angular motion for each step.

The researchers found unilateral foraminotomy did not significantly increase flexion-extension range of movement, nor did it increase range of motion to a greater-than-normal degree. Bilateral foraminotomies were found to increase flexion-extension range of motion; however, motion remained within a physiological range, according to the researchers.

Performing a full laminectomy in the presence of bilateral foraminotomies resulted in significantly increased range of motion but also had the greatest load-displacement curve distortion, which was suggestive of non- physiological motion, according to the researchers.

Brody and colleagues wrote that future disc replacements should account for changes after posterior decompression for same-segment disease.