Evaluation of donor site pain after anterior iliac crest harvesting for cervical fusion: a prospective study on 50 patients

Shamsaldin, M.; Mouchaty, H; Desogus, Nicola; Costagliola, C.; Lorenzo, Nicola Di

doi:10.1007/s00701-006-0864-8

Cited by 33 publications

(17 citation statements)

References 29 publications

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“…Reports of minor complications besides pain and acute paraesthesia for open procedures varies between 1.5 and 14.3% most of which had resolved at follow-up [12,22,[25][26][27][28]. Our complication rate of 8.3% therefore compares favourably with these reports.…”

Section: Discussionsupporting

confidence: 75%

Donor site morbidity following iliac crest bone harvesting for cervical fusion: a comparison between minimally invasive and open techniques

et al. 2008

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We have studied the occurrence of donor site morbidity, cosmesis and overall satisfaction with graft procedure in 76 patients who had undergone iliac crest bone harvesting for anterior cervical discectomy and fusion (ACDF). Totally 24 patients underwent an open procedure and 52 a minimally invasive trephine harvesting method. Although our study demonstrated substantial donor site pain and its effect on ambulation in both groups, this was of limited duration. Two patients, one in each group, suffered long-term pain that was eventually resolved. Totally 8.3% of patients in the open group suffered minor complications and 11.5% in the trephine group. There were two cases of meralgia parasthetica. There were no major complications in either group. There was no statistically significant difference in morbidity between the open and trephine groups. There was a trend towards significance (P = 0.076) for pain at the donor site, with less pain reported by patients who underwent the trephine procedure for harvesting.

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Section: Discussionsupporting

confidence: 75%

Donor site morbidity following iliac crest bone harvesting for cervical fusion: a comparison between minimally invasive and open techniques

et al. 2008

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“…Silber et al [86] noticed serious impairments in functional activities of daily living in about 10% of patients due to the iliac crest site and mean VAS was 3.8 at 4 years follow-up. In contrast, Shamsaldin et al [84] demonstrated that after harvesting bone from the iliac crest for 1-level ACDF, 92% had no persisting pain after 1 year. Likewise, in a series on thoracolumbar fractures Delawi et al [22] reported donor site pain in 14%, but 'pain' on a VAS averaged 1.6 only [22].…”

Section: Complicationsmentioning

confidence: 92%

Mid- to long-term outcome of instrumented anterior cervical fusion for subaxial injuries

et al. 2009

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The management of patients with subaxial cervical injuries lacks consensus, particularly in regard to the decision which surgical approach or combination of approaches to use and which approach yields the best clinical outcome in the distinct injury. The trauma literature is replete with reports of surgical techniques, complications and gross outcome assessment in heterogeneous samples. However, data on functional and clinical outcome using validated outcome measures are scanty. Therefore, the authors performed a study on plated anterior cervical decompression and fusion for unstable subaxial injuries with focus on clinical outcome. For the purpose of a strongly homogenous subgroup of patients with subaxial injuries without spinal cord injuries, robust criteria were applied that were fulfilled by 28 patients out of an original series of 131 subaxial injuries. Twenty-six patients subjected to 1-and 2-level fusions without having spinal cord injury could be surveyed after a mean of 5.5 years (range 16-128 months). The cervical spine injury severity score averaged 9.6. Cross-sectional outcome assessment included validated outcome measures (Neck pain disability index, Cervical Spine Outcome Questionnaire, SF-36), the investigation of construct failure and successful surgical outcome were defined by strict criteria, the reconstruction and maintenance of local and total cervical lordosis, adjacent-segment degeneration and intervertebral motion, and the fusion-rate using an interobserver assessment. Selfrated clinical outcome was excellent or good in 81% of patients and moderate or poor in 19% that corresponded to the results of the validated outcome measures. Results of the NPDI averaged 12.4 ± 12.7% (0-40). With the SF-36 mean physical and mental component summary scores were 47.0 ± 9.8 (18.2-59.3) and 52.2 ± 12.4 (14.6-75.3), respectively. Using merely non-constrained plates, construct failure was observed in 31% of cases and loss of local lordosis, expressed as a mean injury angle of 14°, postoperative angle of -5.5°and follow-up angle of -1°, was significant. However, total cervical lordosis was within the limits of normalcy (-24.3°± 13.3) and fusion-rate was 88.5%. The progression of adjacent-level degeneration was shown to be significantly influenced by a decreased plate-to-disc-distance. Adjacent-level intervertebral motion was not altered due to the adjacent fusion, but reduced in Electronic supplementary material The online version of this article

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“…1,8,13 However, the iliac crest is not an ideal donor site, because a variety of donorsite morbidities can result from its use. 2,7,12,[15][16][17] This has led to the search for other autologous donor sites. 6,9 Cadaveric allografts and synthetic bone materials have been reported as alternatives to avoid harvesting autografts, 6,8,9,14 but none are superior to autografts.…”

Section: Discussionmentioning

confidence: 99%

“…The reported incidence of chronic iliac donor-site pain ranges from 26% to 34%, with approximately 3%-10% patients reporting severe chronic pain. 8,16,17 This high incidence may result from injury to the lateral femoral cutaneous nerve or its branch during iliac crest autograft harvesting. Thorough knowledge of a patient's anatomy is required to avoid nerve injury.…”

Section: Discussionmentioning

confidence: 99%

Autologous clavicle bone graft for anterior cervical discectomy and fusion with titanium interbody cage

Iwasaki

Ikedo

Hashikata

et al. 2014

SPI

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A variety of donor-site complications have been reported for anterior cervical discectomy and fusion (ACDF) using autologous iliac bone graft. To minimize such morbidities and to obtain optimal bony fusion at the ACDF surgery, a novel technique was used to harvest cancellous bone from the autologous clavicle instead of the popular iliac crest graft. After a routine cervical discectomy of the affected level, a 1.5-cm linear skin incision was made over the clavicle within 2.5 cm of the sternoclavicular joint on the medial one-third portion. This portion is known as an anatomically safe zone, with no subcutaneous distribution of the supraclavicular nerve. Then, cancellous bone was harvested through a small cortical window developed on the clavicle. Care was taken not to injure the subclavian major vessels and the lung below the clavicle. A box-type titanium cage was packed with the harvested cancellous bone and then inserted into the discectomy-treated space for cervical interbody fusion. From 2009 to 2013, 16 patients with cervical radiculopathy and/or myelopathy underwent single-level ACDF with this method. All but 1 patient experienced significant improvement of clinical symptoms after the surgery and showed radiographic evidence of solid bony fusion and spinal stabilization within 6 months. Further, no peri- and postoperative complications at the clavicular donor site were noted. The mean visual analog scale pain score (range 0 [no pain to 10 [maximum pain]) at 1 year after the surgery was 0.1, and 13 of 14 patients with data at 1-year follow-up were highly satisfied with their donor-site cosmetic outcome. The clavicle is a safe, reliable, and technically easy source of autologous bone graft that yields optimal fusion rates and patient satisfaction with ACDF surgery.

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Evaluation of donor site pain after anterior iliac crest harvesting for cervical fusion: a prospective study on 50 patients

Cited by 33 publications

References 29 publications

Donor site morbidity following iliac crest bone harvesting for cervical fusion: a comparison between minimally invasive and open techniques

Donor site morbidity following iliac crest bone harvesting for cervical fusion: a comparison between minimally invasive and open techniques

Mid- to long-term outcome of instrumented anterior cervical fusion for subaxial injuries

Autologous clavicle bone graft for anterior cervical discectomy and fusion with titanium interbody cage

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