Pain from donor site after anterior cervical fusion with bone graft: a prospective randomized study with 12 months of follow-up

Abstract

Introduction Harvesting bone graft from the iliac crest in spinal fusion surgery is a widely used technique. However, complications can occur and there are also reports of patients with persistent graft site pain after surgery. The aim of this study was to evaluate pain from the donor site (DS) over time, and register associated complications and if it affected health-related quality of life (HRQoL). Material and methods One hundred and seven patients participating in an RCT between two different methods of reconstruction after cervical decompression were included in this study. One group underwent surgery with bone graft (BG) from the iliac crest and the other with no bone graft (NBG). All patients were evaluated concerning pain at DS and HRQoL preoperatively, at 4 weeks, 3 months and 1 year. Pain was evaluated with visual analog scale (VAS) and HRQoL with EQ-5D. Results A statistically significant difference was found at all times of follow-up in the BG group compared to preoperative levels and the NBG group. The VAS levels at follow-ups at 3 months and 1 year were however of questionable clinical importance. Two patients in the BG group had superficial wound infections postoperatively and five patients still had sensory disturbance in the area of graft site at 12 months. No major complications were registered. No difference could be seen in EQ-5D at any time of follow-up between the groups. Conclusion Harvesting of iliac crest bone graft is associated with significant pain. However, at 3 months postoperatively, the negative effect of clinical importance seemed to have disappeared compared to when no bone graft was harvested. The pain from bone graft harvesting does not seem to affect the quality of life at 4 weeks postoperatively and onward.

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

“…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.…”

“…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.…”

Results of 10-year follow-up of the iliac donor site of graft patients

“…1 Harvesting of the iliac crest graft is associated with morbidity, particularly persistent pain at the graft harvest site, in up to one-third of patients. 4,5 However, the most recent studies have reported incidences of relevant pain with a follow-up of 3 years. The present study is is the first prospective study to examine pain and bone regeneration with a follow-up of 10 years.…”

Évaluation de critères d’interprétation de la tomoscintigraphie d’émission monophotonique au 99mTC-HMDP pour le diagnostic des complications tardives des arthrodèses rachidiennes

“…Les autogreffes (prise de greffon au niveau de la crête iliaque postérieure, de la fibula ou à partir des produits issus d'une éventuelle laminectomie) sont utilisées en première intention car elles sont idéales. Elles remplissent les trois caractéristiques nécessaires à la construction osseuse : elles sont à la fois ostéogéniques (comportant des cellules mésenchymateuses non différenciées à potentiel ostéogénique), ostéo-inductrices (comportant des facteurs d'induction de croissance osseuse) et ostéoconductrices (le greffon sert d'échafaudage pour la construction osseuse provenant de l'os hôte et permet également la néovascularisa-tion) [27]. À défaut, une allogreffe peut être réalisée (os de banque) ou des substituts synthétiques peuvent être employés (matériel céramique constitué de biphosphonates et de pyrophosphate tricalcique) [28].…”