Effect of graft size on graft fracture rate after anterior lumbar spinal fusion in a sheep model

Study designSheep anterior spinal fusion model with autogenous and xenogenous bone grafts.ObjectiveTo investigate whether the relationship between cross-sectional area of the bone graft and area of the adjacent vertebral endplates has an effect on graft fracture rate.Summary of background dataAnterior spondylodesis with autogenous iliac crest transplant is a frequently performed operation to stabilize spinal motion segments but to date no precise recommendations with respect to minimum graft size are available in the literature.MethodsAnterior spondylodesis using autogenous and xenogenous grafts of constant size in combination with an angular stable plate (Macs TL®). Autogenous iliac crest graft was inserted in eight sheep and xenogenic, commercially available bovine graft (Tutobone®) in the additional eight animals.The surface areas of the endplates of the fused intervertebral space were calculated using CT scans and contact radiographs of the specimens obtained after 24 weeks. The graft itself was evaluated for fractures and osteolysis.ResultsA fracture occurred in tricortical, autogenous grafts if the graft cross-sectional area was less than 21% of the area of the adjacent endplates. All xenogenic grafts fractured and therefore a comparable value could not be determined.ConclusionThe results clearly indicate that the relation between graft cross-sectional area and endplate area defines the survival or fracture of the graft in anterior spinal fusion. Although it is difficult to directly apply the results to the clinical situation it is suggested to choose a sufficiently large graft, in order to reduce the risk of autogenous graft fracture in anterior spondylodesis.