Risk Factors Associated With Femoral Ring Allograft Breakage in ALIF. Issue 1 (January 2021)

• Record Type: Journal Article
• Authors: Philipp, Travis; Radoslovich, Stephanie S.; Yoo, Jung U.
• Is Part Of: Global spine journal. Volume 11:Issue 1(2021)
• Page Start: 57
• Page End: 62
• Publication Date: 2021-01
• Subjects: lumbar -- fusion -- lumbar interbody fusion -- radiology -- CT -- lumbosacral; Spine -- Diseases -- Periodicals; Spine -- Diseases -- Treatment -- Periodicals; Spine -- Abnormalities -- Periodicals; Spine -- Surgery -- Periodicals; 616.73
• DOI: 10.1177/2192568219890294
• Languages: English
• ISSNs: 2192-5682

Abstract

Study design: This is a retrospective chart review. Objectives: To identify the incidence of, and variables correlated with, femoral ring allograft (FRA) fracture following anterior lumbar interbody fusion (ALIF). Methods: All patients who underwent ALIF using FRAs at an academic institution over 10 years were included. Postoperative radiographs were reviewed by both the primary and senior authors; fracture and no-fracture groups were created for comparison. Patient and surgical characteristics were extracted from electronic medical records. Frequency data comparisons were performed using contingency table analysis; comparisons of means were analyzed for continuous variables. A multivariate linear regression model was developed using screw use, graft height <12 mm, index level, and weight as variables. Results: A total of 76 FRAs in 59 patients were identified, 13 (17%) of which fractured. Age, sex, smoking status, use of buttress screws, weight, index level, and presence of spondylolisthesis were not correlated with incidence of fracture ( P > .05). There was a significant correlation between the height of FRA and incidence of fracture; 2% (1/52) of grafts ≥12 mm and 50% (12/24) of grafts <12 mm fractured ( P < .0001). Using ordinary least-squares regression, this result was independent of patient weight, use of screws, and index level. Of 10 patients, 9 did not require revision surgery to achieve fusion. Conclusions: Graft height was the only variable correlated with incidence of FRA fracture. Graft height <12 mm is an independent risk factor for FRA fracture in patients undergoing ALIF, and their use should be avoided in ALIF procedures.