Successful Treatment of Chronic Donor Site Pain

Abstract

Introduction:This is a case presentation of a 45-year-old male with chronic donor site pain following autologous iliac crest bone harvest successfully treated with superior cluneal nerve blockade. Donor site pain following autologous bone harvest is a common postoperative complication of lumbar fusion procedures that can cause significant morbidity and diminish quality of life, even in the context of an otherwise successful surgery. Dysfunction of the superior cluneal nerves is an etiology of this chronic pain. The patient’s medical history, attempted treatments, and literature were reviewed.Case Presentation:A 45-year-old male with a six year history of severe pain over the right iliac crest following an otherwise successful lumbar laminectomy and fusion underwent two sets of superior cluneal nerve blocks, with sustained relief of more than 80% at seven months follow up.Conclusions:Donor site pain following autologous iliac crest bone harvest is a common surgical complication that is often resistant to conservative treatments such as physical therapy and oral medications. Blockade of the superior cluneal nerves is a safe and technically simple procedure that may result in long-term pain relief, obviating the need to consider more invasive options.

Donor Site Morbidity as a Problem of Spinal Surgery: Systematic Review

“…При заборе трансплантатов из гребня подвздошной кости возможно повреждение латерального кожного нерва бедра, верхних кожных нервов ягодиц, подвздошноподчревного, подвздошно-пахового и бедренного нервов [23,34]. Значение интраоперационной травмы нервных стволов для последующего развития болевого синдрома подтверждается сообщением об успешном лечении хронических болей блокадой верхних кожных нервов ягодиц [63]. 4.…”

Improving outcomes in spinal surgery patients

“…Acute post-operative pain and nerve injuries at anterior iliac crest bone graft can lead to neuropathic, chronic pain. [22] • Incidence: 2.8-25%…”

“…Injury to lateral cutaneous nerve of thigh can result in meralgia paraesthetica. [22] A small study evaluated the efficacy of pre-operative placement of transversus abdominis plane (TAP) block under ultrasound-guided technology. The authors considered TAP to be an appropriate technique for post-operative analgesia at the bone harvest as about 80% of patients had no pain at 18 months.…”