Acute and Chronic Complications of Intracortical Iliac Crest Bone Grafting Versus the Traditional Corticocancellous Technique for Spinal Fusion Surgery

Abstract

Although autologous bone graft from the iliac crest is the gold standard for most spinal fusion applications, it is known to cause significant graft-site morbidity. Unlike the traditional corticocancellous allograft, the intracortical method leaves the iliac crest in continuity and decreases the surgical incision and overall area of dissection. We hypothesized this modified technique would decrease pain and complication rate. We first performed an extensive literature review to ascertain which questions, variables, and results were found to be statistically significant regarding the postoperative course and complication rates in patients who underwent iliac crest bone grafting. We then created an Iliac Crest Bone Graft survey that was mailed to 293 patients who had undergone intracortical iliac crest bone graft at our institution to assess postoperative pain and complications.One hundred one (34.5%) surveys were returned. Differences in chronic pain between the surgical types (cervical, lumbosacral, traumatic, and scoliosis) using the intracortical technique showed a trend toward statistical significance (F=2.42, P<.071); this trend was mostly due to no chronic pain reported in the cervical and traumatic groups. Patients experiencing chronic pain at their graft site using the intracortical technique had a statistically significant difference in pain between the same incision versus a separate incision (F=5.05, P<.027), with a separate incision having lower reported pain. After meta-analyses were performed with articles obtained in the literature search using the traditional corticocancellous technique and compared to our results, the only variable that obtained statistical significance was decreased chronic pain at 2 years with the intracortical method in our study (P<.001).