Abstract
Purpose of study: The purpose of the study was to evaluate acute and chronic problems associated with anterior iliac crest bone graft donation for single-level anterior cervical discectomy and fusion (ACDF), particularly long-term functional outcomes and impairments resulting from graft donation.Methods used: A questionnaire was mailed to 187 consecutive patients who were retrospectively identified to have undergone autologous anterior iliac crest bone harvest (ICBG) harvest for single-level ACDF between 1994 and 1998. The questionnaire divided items into symptomatic (acute and chronic) and functional assessments. Patients answered either yes, no or not applicable; pain was assessed with a visual analog scale (VAS).of findings: Surveys were completed either by mail or follow-up telephone interview by 134 patients (71.6%). Average follow-up was 48 months (range, 24 to 72 months). Acute symptoms were reported at the following rates: ambulation difficulty, 50.7%; extended antibiotic usage, 7.5%; persistent drainage, 3.7%; wound dehiscence, 2.2% and incision and drainage, 1.5%. The chronic symptom questionnaire demonstrated a high degree of satisfaction with the cosmetic result (92.5%). Pain at the donor site was reported by 26.1% of patients with a mean VAS score of 3.8 of 10, and 11.2% chronically used pain medication. Twenty-one patients (15.7%) reported dysthesias at the donor site, but only 5.2% reported discomfort with clothing. Functional assessment revealed current impairments at the following rates: ambulation, 12.7%; recreational activities, 11.9%; work activities, 9.7%; activities of daily living, 8.2%; sexual activity, 7.5% and household chores, 6.7%.Relationship between findings and existing knowledge: The basic principles of an ACDF procedure include adequate decompression and a biologically compatible bone graft providing restoration of structural integrity and allowing a solid bony union. When autologous iliac crest bone graft is used, however, possible donor site morbidity must be taken into account. Similar to previous studies, the present study demonstrated substantial donor site morbidity, even at long-term follow-up. This study is unique, however, in that it also explores long-term functional outcome, and the results demonstrate significant impairment in day-to-day activities relating to anterior iliac crest bone graft donation site.Overall significance of findings: A large percentage of patients report chronic donor site pain after anterior ICBG donation, even when only a single-level ACDF procedure is performed. Moreover, long-term functional impairment can also be significant. Patients should be counseled regarding these potential problems, and alternative sources of graft material should be considered.Disclosures: No disclosures.Conflict of interest: No conflicts.
Published Version
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