Outcomes Following Posterior Fusion for Adolescent Idiopathic Scoliosis With and Without Autogenous Iliac Crest Bone Graft Harvesting

Abstract

Study DesignRetrospective. Summary of Background DataThere is continued controversy regarding the morbidity associated with harvesting iliac crest bone graft (ICBG). More important, its effect on clinical outcomes is poorly understood. ObjectivesThe purpose of this study was to determine whether harvesting ICBG affects clinical outcomes after posterior instrumented fusion in patients with adolescent idiopathic scoliosis (AIS). MethodsWe identified patients enrolled in a prospective, multicenter database of patients with AIS who had posterior instrumented fusion with complete preoperative and 2-year postoperative Scoliosis Research Society (SRS)-22R data. Patients who had a previous fusion, thoracoplasty, or anterior surgery were excluded. We classified patients into 2 groups: those who underwent ICBG harvest (ICBG group) and those who did not (non-ICBG group). ResultsWe included 342 patients in the ICBG group versus 563 in the non-ICBG group. There were no significant differences in preoperative age (14.9 vs. 14.8; p = .178), major Cobb angle (51.3 vs. 51.8; p = .782), minor Cobb angle (34.8 vs. 35.1; p = .846), or Pain (4.11 vs. 4.11; p = .912), Appearance (3.29 vs. 3.33; p = .384), Activity (4.15 vs. 4.14; p = .847); Mental (3.95 vs. 4.00; p = .313), or Total (3.86 vs. 3.87; p = .603) SRS-22R scores. The average operative time was slightly longer in the ICBG group (293.55 vs. 276.21 minutes; p = .002). Estimated blood loss was greater in the ICBG group (939.47 vs. 723.63 mL; p = .000; 12.2% vs. 9.2% estimated blood volume; p = .000). The average number of levels fused was similar between groups (10.6 vs. 10.3; p = .137). There were no significant differences in any of the postoperative SRS-22R domains: Pain (4.30 vs. 4.34; p = .373), Appearance (4.23 vs. 4.19; p = .310), Activity (4.31 vs. 4.33; p = .509), Mental (4.20 vs. 4.23; p = .532), Satisfaction (4.42 vs. 4.43; p = .870), or Total Score (4.27 vs. 4.29; p = .674). By 2-year follow-up, there was 1 nonunion reported in the ICBG group and none in the non-ICBG group. ConclusionsAfter posterior instrumented fusion surgery for AIS, ICBG harvesting was associated with longer operative times and increased blood loss, but did not influence 2-year outcomes, which included pain and appearance scores.