[Spinal Fusion, Microdiscectomy & Laminectomy Procedures] Prospective study of iliac crest bone graft harvest site pain and morbidity

[Justin]

The Spine Journal. Volume 9, Issue 11, November 2009, Pages 886-892

Prospective study of iliac crest bone graft harvest site pain and morbidity

David H. Kim MDa, , , Richard Rhim MDa, Ling Li MPHb, Juli Martha BSc, Bryan H. Swaim BAc, Robert J. Banco MDa, Louis G. Jenis MDa and Scott G. Tromanhauser MDa. aDepartment of Orthopedic Surgery, Tufts University School of Medicine, 125 Parker Hill Avenue, Boston, MA 02120, USA. bDivision of Research, New England Baptist Hospital, 125 Parker Hill Avenue, Boston, MA 02120, USA. cDivision of Research, Department of Orthopedic Surgery, New England Baptist Hospital, 125 Parker Hill Avenue, Boston, MA 02120, USA. © 2009 Elsevier Inc. All rights reserved.

Background context

Morbidity associated with autologous bone graft harvest is an important factor in determining the utility of expensive alternatives such as recombinant bone morphogenic protein. The most frequently reported complication associated with graft harvest is chronic pain.

Purpose

To prospectively determine the degree of pain and morbidity associated with autologous iliac crest bone graft harvest and its effect on activities of daily living.

Study design

Prospective observational cohort study.

Patient sample

One hundred ten adult patients undergoing elective posterior lumbar spinal fusion surgery involving autologous iliac crest bone graft harvest.

Outcome measures

Patient self-reported Visual Analog Scale (VAS) scores for pain and a study-specific questionnaire regarding activities of daily living.

Methods

One hundred ten patients were prospectively enrolled. Postoperative VAS scores (0–100) for harvest site pain were obtained at 6-week, 6- and 12-month follow-up. Patients completed a 12-month questionnaire regarding the persistence of specific symptoms and resulting limitation of specific activities.

Results

One hundred four patients were available for 1-year follow-up. Mean VAS pain scores (scale 0–100) at 6 weeks, 6 and 12 months were 22.7 (standard deviation [SD], 25.9), 15.9 (SD, 21.5), and 16.1 (SD, 24.6), respectively. At 12 months, 16.5% reported more severe pain from the harvest site than the primary surgical site, 29.1% reported numbness, and 11.3% found the degree of numbness bothersome, whereas 3.9% were bothered by scar appearance. With respect to activity limitations resulting from harvest site pain at 1 year, 15.1% reported some difficulty walking, 5.2% with employment, 12.9% with recreation, 14.1% with household chores, 7.6% with sexual activity, and 5.9% irritation from clothing.

Conclusions

There is a significant rate of persistent pain and morbidity from iliac crest bone graft harvest when associated with elective spine surgery. Mean pain scores progressively decline over the first postoperative year. Nevertheless, harvest site pain remains functionally limiting in a significant percentage of patients 1 year after surgery. Rates of functional limitation are higher than previously reported and may be because of increased sensitivity of the prospective study design and targeted investigation of these specific symptoms. Validity of these findings is necessarily limited by patient ability to discriminate harvest site pain from alternative sources of back and buttock pain.

Bone graft; Iliac crest; Harvest site pain; Spinal fusion; Complications

[Katie]

So what are the alternatives, if any, to using the donor bone?

Was there not an artificial bone material introduced a while ago, but was taken off the market because of difficulties? I may have those facts very wrong, and if so, please correct me.