Optimal Selection and Preparation of Fresh Frozen Corticocancellous Allografts for Cervical Interbody Spinal Fusion

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Abstract

Study Design.

Iliac crest corticocancellous allografts for anterior interbody fusion were harvested from six cadavers. The grafts were cut sequentially from left and right crests and randomly assigned to tricortical or bicortical preparations. Their compression strengths then were determined and compared by matched pair analysis.

Objectives.

To quantify the failure strength of the grafts from different iliac locations and determine the optimal type of preparation of the grafts for anterior interbody fusion.

Summary of Background Data.

Iliac crest corticocancellous autografts and allografts commonly are used for interbody cervical fusions. However, graft strengths for specific sites have not been determined fully.

Methods.

Six paired, fresh frozen, iliac crests were sectioned using a customized miter box into multiple 1-cm-thick grafts 1.5 cm in depth to simulate cervical interbody grafts. The left and right sides of each pair were randomly assigned to tricortical and bicortical preparations. The samples were tested by applying a compressive load to failure using a specialized fixture to simulate vertebral body loading.

Results.

The grafts closer to the anterosuperior iliac spine had significantly higher failure loads and failure strengths than those closer to the posterosuperior iliac spine. The strengths of the bicortical grafts were 72 ± 14% of the strengths of the tricortical grafts (P < 0.001).

Conclusions.

Anterior iliac crest grafts were stronger in compression, even after removal of one cortical surface, than posterior iliac crest grafts.

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