Initial results of anterior interbody fusion achieved with a less invasive bone harvesting technique

Study Design. A retrospective review. Objective. To review the initial experience using a trephine bone harvesting system from the local lumbar spine for use in anterior interbody fusions, analyzing fusion rates and complications. Summary of Background Data. Historically, autogenous bone for lumbar spine fusions has been procured from the iliac crest. No data exist regarding the use of a trephine bone harvesting system for obtaining cancellous bone locally from the lumbar spine for use in anterior interbody fusions. In this technique, the donor site is replaced with a corticocancellous humeral dowel. Methods. A total of 36 patients who underwent anterior lumbar interbody fusion were retrospectively reviewed. There were 56 interbody fusions performed using 36 trephine donor sites. Twenty individuals had the bone divided between 2 fusion levels, placed within allograft femoral rings, and 16 had the bone applied to 1 fusion level. Radiographs were analyzed for complications associated with the fibular dowel and time to interbody fusion. Results. By 6 months, 35 of 36 (97%) of the corticocancellous fibular dowels had incorporated. Two dowels migrated 3 mm, each without sequelae. Of 56 of interbody spaces, 50 (89%) were fused. Two eventually fused at 9 and 11 months, and 4 (7%) failed to unite by 15 months. Conclusion. Harvesting cancellous autograft anteriorly from the lumbar spine using a trephine technique appears to be safe and reliable, with satisfactory fusion rates. Iliac crest graft harvesting with its attendant morbidity is avoided.