The Evaluation of Donor Site Pain After Harvest of Tricortical Anterior Iliac Crest Bone Graft for Spinal Surgery: A Prospective Study.

Abstract

STUDY DESIGN:

A prospective cohort.

OBJECTIVE:

The aim of this study was to prospectively observe donor site pain, health-related quality-of-life outcomes, and complications following harvest of tricortical anterior iliac crest bone graft (AICBG) for anterior cervical discectomy and fusion (ACDF).

SUMMARY OF BACKGROUND DATA:

Persistent donor site pain from the anterior iliac crest has been reported to range between 2% and 40%. This morbidity has led surgeons to consider interbody alternatives for ACDF, which carry additional costs.

METHODS:

We prospectively enrolled 50 patients from 2 tertiary care centers over the course of 1 year observing complications and patient-reported outcomes. Patients filled out SF-12 and numeric rating scale (NRS) for pain in the arm, neck, and donor site pre-operatively and at 1 week, 2 weeks, 6 weeks, 3 to 6 months, and 1 year postoperatively. Outcomes were compared with a control group undergoing ACDF with allograft or Polyether ether ketone cages at 1 year.

RESULTS:

The mean ± SD donor site pain at 1 week was 5.6 ± 2.8 but decreased to 2.2 ± 2.4 at 6 weeks and 1.1 ± 1.8 at 1 year (P < 0.001). Including the 3 patients who were lost to follow-up, 10% of patients may have experienced persistent moderate or worse pain at 1 year. Linear regression analysis demonstrated that preoperative opioid use was an independent risk factor for increased donor site pain at 1 and 2 weeks (P < 0.05). There were no differences in outcomes at 1 year compared with the nonautograft group. There were 2 (4%) minor wound complications, both treated successfully with oral antibiotics.

CONCLUSION:

Tricortical AICBG for ACDF is not associated with major complications and only 4% of patients (potentially, maximum of 10%) experienced moderate, persistent donor site pain at 1 year. There is no difference in health-related outcomes between patients who have autograft with those who did not at 1 year. Preoperative opioid use is associated with increased donor site pain within the first 2 weeks postoperatively but not in the long term. At 6 weeks postoperatively, patients can expect the majority of their donor site pain to be resolved.

LEVEL OF EVIDENCE:

2.

• Authors: Sheyan J Armaghani, Jesse L Even, Emily K Zern, Brett A Braly, James D Kang, Clinton J Devin
• Journal: Spine (Spine (Phila Pa 1976)) Vol. 41 Issue 4 Pg. E191-6 (Feb 2016) ISSN: 1528-1159 [Electronic] United States
• PMID: 26571154 (Publication Type: Journal Article)

Topics

• Adult
• Bone Transplantation
• Diskectomy
• Female
• Humans
• Ilium (physiopathology, surgery)
• Male
• Middle Aged
• Multivariate Analysis
• Pain, Postoperative (epidemiology)
• Prospective Studies
• Quality of Life
• Spinal Fusion
• Tissue Donors (statistics & numerical data)
• Tissue and Organ Harvesting (adverse effects)