Use of the scapular spine in lumbar fusion procedures: cadaveric feasibility study

Laboratory Investigation

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Object

Graft sources for lumbar fusion include synthetic materials, donor grafts, and autologous bone such as the iliac crest. Considering the data indicating that autologous bone grafts generate the best results for fusion, the next logical step is to seek alternative donor sites in an attempt to reduce the complications associated with these procedures. To the authors' knowledge, autologous scapula has not been explored as a potential source for posterior lumbar fusion graft material. Therefore, the following study was performed to verify the utility of this bone in these procedures.

Methods

Six adult cadavers (mean age 71 years), four formalin-fixed and two fresh specimens, were used in this study. With the cadaver in the prone position, an incision was made over the spine of the scapula. Soft tissues were stripped from the middle of this region of the scapula, and bone segments were removed with a bone saw and used for a posterior lumbar fusion procedure.

Results

A mean length of 11.5 cm was measured for the spine of the scapula and the mean thicknesses of this bone at its medial part, segment just medial to the spinoglenoid notch, and acromion were 1 cm, 2.2 cm, and 2.5 cm, respectively. No obvious injury to surrounding vessels or nerves was found using this procedure, and adequate fusion was achieved with it.

Conclusions

Following clinical testing, such a bone substitute as autologous scapular spine might be a reasonable alternative to iliac crest grafts for use in posterior lumbar fusion procedures.

Abbreviations used in this paper:PLIF = posterior lumbar inter-body fusion.

Article Information

Address correspondence to: R. Shane Tubbs, Ph.D., Pediatric Neurosurgery, Children's Hospital, 1600 7th Avenue South, ACC 400, Birmingham, Alabama 35233. email: rstubbs@uab.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Artist's illustration of the procedure performed in this study. The scapular spine can be harvested and used in PLIF procedures.

  • View in gallery

    Photographs. A: The left posterior shoulder region of a cadaver. The superior and inferior angles of the scapula and spine have been marked. B: In the same cadaver, the scapular spine (S) is seen. The trapezius (arrow) and supraspinatus have been dissected off superiorly, and the deltoid and infraspinatus inferiorly.

  • View in gallery

    Photographs of a segment of scapular spine removed from a cadaver. The width of this sample was approximately 1 cm (A), and the length was approximately 3 cm (B).

  • View in gallery

    After laminectomy and retraction of dural and neural elements, a portion of scapular spine is seen inserted (arrow) between two lumbar bodies where the intervertebral disc has been removed.

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