Harvest Site Pain Research Articles

Iliac Crest Bone Graft Donor Site Pain After Anterior Lumbar Interbody Fusion

Autogenous iliac crest bone is the gold-standard graft for spinal fusion surgery. Unfortunately, there is a frequent incidence of graft site pain that persists well into the postoperative period with complication rates reported in 2.8-39% of patients. Persistent pain lasting at least 2 years is reported in 15-39% of patients. The objective of this work was to determine the incidence of acute and persistent pain as well as patient assessment of graft site appearance following iliac crest bone graft harvest for anterior lumbar interbody fusion (ALIF). The control arms of four randomized prospective multicenter clinical trials evaluating recombinant human bone morphogenetic protein-2 (rhBMP-2) versus autogenous iliac crest bone graft were combined. Two hundred eight patients underwent iliac crest bone graft harvest for ALIF in threaded cylindrical cages or threaded bone dowels. Patients were assessed at each postoperative visit with questionnaires evaluating graft site pain intensity, duration, and appearance. Two hundred eight patients underwent iliac crest bone graft harvest for ALIF as the control group of four randomized prospective multicenter clinical trials evaluating rhBMP-2 versus autogenous iliac crest bone graft in threaded cylindrical cages or threaded bone dowels. Most patients in the control group had anterior iliac crest graft harvest, equally from the right and left side. Three grafts (1.4%) were taken from the posterior crest and six (2.9%) were tricortical. Follow-up was obtained at hospital discharge, 6 weeks, 3, 6, 12, and 24 months. A pain evaluation score was made up of two Visual Analog Scales: one scale measuring intensity, the other frequency of pain. For the intensity scale, a rating of "0" meant no pain and "10" was "as bad as it could be." For the frequency scale, a rating of "0" meant pain was present "none of the time" and "10" meant it was present "all the time." Combining these scales, a total score of 20 indicated the worst pain was present all the time. Patients were also questioned about the graft site appearance. Two hundred eight patients underwent iliac crest harvest, and prospective data were available on 202 patients. At hospital discharge, 2 patients (1%) had no pain; this increased to 34 of 199 (17%) at 6 weeks postoperatively and to 85 of 199 patients (43%) at 3 months. However, 41% of patients reported pain at 6 months postoperatively (79/192), and 33% of 168 reported pain at 1 year. One hundred forty-one of 208 patients completed a survey at 24 months, with 31% reporting some level of pain. At hospital discharge, the graft site pain score ranged from 0 to 20 with a mean of 12.8, decreasing to 7.3 at 6 weeks, to 3.8 at 3 months, and to 2.9, 2.4, and 1.8 at 6, 12, and 24 months, respectively. At all time intervals, P values from t tests comparing the mean with 0 were <0.001. Graft site appearance at discharge was good in 49% of patients, fair in 40%, and poor in 11%. At 6 weeks, appearance was good in 69%, fair in 27%, and poor in 5%; at 3 months, it was good in 75%, fair in 24%, and poor in 2%; at 6 months, it was good in 82%, fair in 15%, and poor in 3%; at 12 months, it was good in 82% and fair or poor in 19%; and at 24 months, it was good in 84% and fair or poor in 16%. There was no significant difference between posterior and anterior harvest sites or bicortical grafts, and all were included in the analysis. Right or left side demonstrated no differences. This is the first study known to the authors presenting results of prospective data collected in a multicenter study evaluating iliac crest harvest site pain, both intensity and frequency, as well as graft site appearance. The results demonstrate that 31% of patients had persistent pain at 24 months postoperatively and 16% reported fair or poor appearance of their graft site. Persistent donor site pain remains a problem with harvest of autogenous iliac crest bone graft for spinal fusion. This prospective study, the first such study reported for ALIF, confirms that donor site pain remains a significant postoperative management problem.

Iliac crest graft site pain after anterior lumbar interbody fusion: a prospective patient outcome assessment

Purpose of study: Autogenous iliac crest bone graft is the gold standard for bone grafting for spinal fusion surgery. Unfortunately, there is a frequent incidence of graft site pain that persists well into the postoperative period. This study reports the results of a prospective study evaluating graft site pain after iliac crest harvest for anterior lumbar interbody fusion (ALIF).Methods used: A total of 208 patients underwent iliac crest bone graft for ALIF as the control group of four randomized prospective multicenter clinical trials evaluating recombinant human bone morphogenic protein (rhBMP)-2 vs autogenous iliac crest bone graft in a threaded cylindrical cages or threaded bone dowels. Most patients in the control groups had anterior iliac crest graft harvest, equally from the right and left side. Three grafts, 1.4%, were taken from the posterior crest, and six, 2.9%, were tricortical. Follow-up was obtained at hospital discharge, 6 weeks, 3, 6, 12 and 24 months. A pain evaluation score made up of two visual analog scales, one scale measuring intensity, the other frequency of pain on a scale of 0 to 10, was used. For the intensity scale, a rating of 0 meant no pain and 10 was “as bad as it could be.” For the frequency scale, a rating of 0 meant pain was present “none of the time” and 10 meant it was present “all the time.” Combining the scores, a total score of 20 indicated the worst pain was present all the time. Patients were also questioned about the graft site appearance.of findings: A total of 208 patients underwent iliac crest harvest and prospective data were available on 202 patients. At hospital discharge, two patients had no pain, 1%; this increased to 34 of 199, 17%, at 6 weeks after surgery and to 85 of 199 patients, 43%, at 3 months. However, 41% of patients (79 of 192) reported pain at 6 months postoperatively, and 33% of 168 reported pain at 1 year. Of 208 patients, 141 completed surveys at 24 months with 31% reporting some level of pain. At hospital discharge, the graft-site pain score ranged from 0 to 20 with a mean of 12.8, SD 4.5, decreasing to 7.3, (SD, 5.6; range, 0 to 20) at 6 weeks; 3.8 (SD, 4.6; range, 0 to 18) at 3 months; and scores of 2.9, 2.4 and 1.8 at 6, 12 and 24 months, respectively. At all time intervals p values were less than .001. Total pain scores combining intensity and frequency greater than or equal to 10, maximum possible 20, were collected at each interval. At discharge 80% (161 of 202) had a pain score of less than 10 (range, 10 to 20). This decreased to 35% (70 of 199; range, 10 to 20) at 6 weeks; 14% (28 of 199 at 3 months; range, 10 to 18); and at 6, 12 and 24 months postoperatively, 13% (25 of 192), 10% (17 of 168) and 7% (10 of 141) respectively. Graft site appearance at discharge was good in 49% of patients, fair in 40% and poor in 11%. At 6 weeks, 69% rated appearance as good, 27% as fair, 5% as poor. At 3 months 75% rated appearance as good, 24% as fair, 2% as poor. At 6 months 82% rated appearance as good, 15% as fair, 3% as poor. At 12 months 82% rated appearances as good, 19% as fair or poor. At 24 months 84% rated appearances as good and 16% as fair or poor. There was no significant difference between posterior and anterior harvest sites or with bicortical grafts, and all were included in the analysis. Right or left side demonstrated no differences.Relationship between findings and existing knowledge: This is the first study known to the authors presenting results of prospective data collected in a multicenter study evaluating iliac crest harvest site pain (intensity and frequency) as well as graft site appearance.Overall significance of findings: The results demonstrate that 31% of patients had persistent pain at 24 months postoperatively, and 16% reported fair or poor appearance of their graft site.Disclosures: No disclosures.Conflict of interest: Rick Sasso, grant research support and, consultant.

Laminoplasty Versus Laminectomy and Fusion for Multilevel Cervical Myelopathy

A matched cohort clinical and radiographic retrospective analysis of laminoplasty and laminectomy with fusion for the treatment of multilevel cervical myelopathy. To compare the clinical and radiographic outcomes of two procedures increasingly used to treat multilevel cervical myelopathy. Traditional methods of treating multilevel cervical myelopathy (laminectomy and corpectomy) are reported to have a notable frequency of complications. Laminoplasty and laminectomy with fusion have been advocated as superior procedures. A comparative study of these two techniques has not been reported. Medical records of all patients treated for multilevel cervical myelopathy with either laminoplasty or laminectomy with fusion between 1994 and 1999 at our institution were reviewed. Thirteen patients that underwent laminectomy with fusion were matched with 13 patients that underwent laminoplasty. All patients and radiographs were independently evaluated at latest follow-up by a single physician. Cohorts were well matched based on patient age, duration of symptoms, and severity of myelopathy (Nurick grade) before surgery. Mean independent follow-up was similar (25.5 and 26.2 months). Both objective improvement in patient function (Nurick score) and the number of patients reporting subjective improvement in strength, dexterity, sensation, pain, and gait tended to be greater in the laminoplasty cohort. Whereas no complications occurred in the laminoplasty cohort, there were 14 complications in 9 patients that underwent laminectomy with fusion patients. Complications included progression of myelopathy, nonunion, instrumentation failure, development of a significant kyphotic alignment, persistent bone graft harvest site pain, subjacent degeneration requiring reoperation, and deep infection. The marked difference in complications and functional improvement between these matched cohorts suggests that laminoplasty may be preferable to laminectomy with fusion as a posterior procedure for multilevel cervical myelopathy.

Donor site morbidity at the iliac crest: comparison of percutaneous and open methods

The Journal of Bone and Joint Surgery. British volumeVol. 76-B, No. 5 ArticlesFree AccessDonor site morbidity at the iliac crest: comparison of percutaneous and open methodsDN Kreibich, IR Scott, JM Wells, M SalehDN KreibichSearch for more papers by this author, IR ScottSearch for more papers by this author, JM WellsSearch for more papers by this author, M SalehSearch for more papers by this authorPublished Online:1 Sep 1994https://doi.org/10.1302/0301-620X.76B5.8083285AboutSectionsPDF/EPUB ToolsAdd to FavouritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited ByCross-sectional analysis of spatial distribution and total amount of harvestable calvarian split boneAnnals of Anatomy - Anatomischer Anzeiger, Vol. 234Trephine Technique for Iliac Crest Bone Graft Harvest16 September 2020 | Spine, Vol. 46, No. 1Treatment of distal clavicle nonunion with and without bone graftingInjury, Vol. 49Application of vascularized fibular graft for reconstruction and stabilization of multilevel cervical tuberculosisMedicine, Vol. 97, No. 3Vascularized Bone Grafts in Spine SurgeryBone Autografting, Allografting and Banking22 April 2014Revisionsendoprothetik20 October 2011Complications following autologous bone graft harvesting from the iliac crest and using the RIA: A systematic reviewInjury, Vol. 42Characterization of cortico-cancellous bone along the iliac crest: focus on graft harvesting4 December 2010 | Surgical and Radiologic Anatomy, Vol. 33, No. 5Complications Related to GraftProspective study of iliac crest bone graft harvest site pain and morbidityThe Spine Journal, Vol. 9, No. 11Percutaneous Bone Grafting from the Distal FemurThe Annals of The Royal College of Surgeons of England, Vol. 90, No. 1The use of irradiated allograft in a paediatric population: an Indian experience28 June 2006 | Cell and Tissue Banking, Vol. 8, No. 1Tissue banking in MexicoCell and Tissue Banking, Vol. 7, No. 3Ambulatory in-office anterior iliac crest bone harvestingOral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, Vol. 101, No. 3Autogenous bone grafting from proximal tibia in elective foot and ankle surgeryFuß & Sprunggelenk, Vol. 4, No. 1The Syringe Technique for Minimally Invasive Bone GraftingJournal of Orthopaedic Trauma, Vol. 19, No. 9Reconstruction of mandibular defects following tumor ablation by vertical distraction osteogenesis using intraosseous distraction devices8 September 2004 | Clinical Oral Implants Research, Vol. 16, No. 1Vascularized Bone Grafts in Spine SurgeryReview Management of nonunion in trauma2 September 2016 | Trauma, Vol. 6, No. 3Two-Year Fusion Rate Equivalency Between Grafton® DBM Gel and Autograft in Posterolateral Spine FusionSpine, Vol. 29, No. 6Long-term complications of distal radius bone graftsThe Journal of Hand Surgery, Vol. 28, No. 5Preservation of ridge dimensions following grafting with coral granules of 48 post-traumatic and post-extraction dento-alveolar defectsDental Traumatology, Vol. 19, No. 4Comparison of conventional surgery with motorized trephine in bone harvest from the anterior iliac crestOral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, Vol. 95, No. 2Clinical success in harvesting autogenous bone using a minimally invasive trephineJournal of Oral and Maxillofacial Surgery, Vol. 61, No. 2Management of non-unions with mono-lateral external fixationInjury, Vol. 32Surgical harvesting of bone graft from the ilium: point of viewMedical Hypotheses, Vol. 55, No. 6The Management of Acute Bone Loss Following TraumaBifocal Techniques for Non-Union and DeformityExternal Fixation Techniques for Arthrodesis of the Knee and AnkleQuantification of bone harvested from the iliac crest using a power-driven trephineJournal of Oral and Maxillofacial Surgery, Vol. 57, No. 7An open fracture of the ulna with bone loss, treated by bone transportInjury, Vol. 30, No. 5Osteogenic effect of a gastric pentadecapeptide, BPC-157, on the healing of segmental bone defect in rabbits: a comparison with bone marrow and autologous cortical bone implantationBone, Vol. 24, No. 3Fracture of the tibial diaphysis treated by external fixation and the axial alignment grid: a single surgeon's experienceInjury, Vol. 28, No. 7Biocompatible Osteoconductive Polymer Versus Iliac GraftSpine, Vol. 21, No. 18External fixation of the wristInjury, Vol. 27, No. 1Bone Allograft Safety and Performance Vol. 76-B, No. 5 Metrics Downloaded 103 times History Published online 1 September 1994 Published in print 1 September 1994 InformationCopyright © 1994, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download