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. 2019 Jun 30;13(3):275-282.
doi: 10.14444/6037. eCollection 2019 Jun.

Harvest of Iliac Crest Autograft Not Associated With Localized Pain

Joseph E Snavely  1 , Ronald W Mercer  2 , Geoffrey Stewart  3
Affiliations

Harvest of Iliac Crest Autograft Not Associated With Localized Pain

Joseph E Snavely et al. Int J Spine Surg. .

Abstract

Background: There exists a wide variety of bone grafts, substitutes, and extenders, which are utilized in spinal arthrodesis surgery. While iliac crest autograft is the traditional gold standard for use in spinal arthrodesis, there is considerable discrepancy in the literature regarding its associated complications. Primarily among these is the perception that the procedure is painful and has a high infection rate. The purpose of this study is to determine if patients experience more pain postoperatively on the iliac crest autograft donor side of the pelvis than the contralateral side.

Methods: This study was a retrospective chart analysis of prospectively collected data on 76 patients who underwent elective lumbar arthrodesis with iliac crest autograft performed by one surgeon. The patients filled out a pain diagram with a five-region visual analogue scale, including each iliac crest, at the preoperative and each postoperative visit. Patient-reported pain data at various time points was compared from donor and contralateral sides and analysis included trends over time. Additionally, complications were noted when they occurred. The surgical approach involved a midline skin incision in all patients with epifascial and subperiosteal dissection to the posterior superior iliac spine.

Results: There were no significant differences in reported pain between donor and nondonor side. There was no significant main effect of side of measurement (P = .75) and no significant side by time of measurement interaction effect (P = .95). There was a significant main effect of time of measurement for both sides (P < .001). There were no cases of donor site complications.

Conclusions: Iliac crest harvest and reconstruction utilizing this technique does not result in increased pain on the side of the harvest. This study supports a low morbidity rate for iliac crest autograft harvest as no complications were seen in this series.

Level of evidence: 3.

Keywords: ICBG; arthrodesis; bone; crest; donor; fusion; graft; harvest; iliac; lumbar; morbidity; pain; postoperative; side.

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Conflict of interest statement

Disclosures and COI: The authors declare no conflicts of interest. The study protocol was reviewed and approved by the University of Central Florida Institutional Review Board.

Figures

Figure 1
Figure 1
Visual analog scale completed by patients at the time of clinical visits. Patients ranked pain on a scale from 0 to 10.
Figure 2
Figure 2
Harvesting of autogenous iliac crest bone graft via a midline skin incision with an epifascial dissection to the posterior superior iliac spine and then subperiosteal exposure of the prominence.
Figure 3
Figure 3
Iliac crest bone marrow aspiration is performed after an epifascial plane is created, prior to harvesting of autograft.
Figure 4
Figure 4
The posterior superior iliac prominence is resected with an osteotomy. Care is taken to avoid penetration of the cortex or sacroiliac joint.
Figure 5
Figure 5
Cancellous iliac crest autograft is removed from between the tables with Capener gouges and will be combined with bone marrow aspirate and allograft and placed in the spinal fusion bed.
Figure 6
Figure 6
Illustration demonstrating resection of the posterior superior iliac prominence with an osteotome.
Figure 7
Figure 7
Illustration demonstrating cancellous iliac crest autograft removal with Capener gouge after osteotomy of posterior superior iliac prominence.
Figure 8
Figure 8
Comparison of patient pain scores at each time point assessing the percentage of patients experiencing more pain on the graft side, more pain on the contralateral side, and equal pain on both sides.
Figure 9
Figure 9
Comparison of patient pain scores on graft side of pelvis and contralateral side at each time point.
See this image and copyright information in PMC

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