Document Detail


Donor site morbidity after anterior iliac crest bone harvest for single-level anterior cervical discectomy and fusion.
MedLine Citation:
PMID:  12544929     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY DESIGN: This retrospective, questionnaire-based investigation evaluated iliac crest bone graft (ICBG) site morbidity in patients having undergone a single-level anterior cervical discectomy and fusion (ACDF) procedure performed by a single surgeon (T.J.A.). OBJECTIVE: To evaluate acute and chronic problems associated with anterior ICBG donation, particularly long-term functional outcomes and impairments caused by graft donation. SUMMARY OF BACKGROUND DATA: Anterior cervical discectomy and fusion procedures frequently use autologous anterior ICBG to facilitate osseous union. Although autologous ICBG offers several advantages over alternative grafting materials, donor site morbidity can be significant. Acute and chronic complications of donor sites have been reported, yet there are currently no reports of long-term functional outcomes after autologous anterior ICBG donation after single-level ACDF. METHODS: A questionnaire was mailed to 187 consecutive patients who were retrospectively identified to have undergone autologous anterior ICBG harvest for single-level ACDF between 1994 and 1998. The questionnaire divided items into symptomatic (acute and chronic) and functional assessments. Patients answered yes, no, or not applicable; pain was assessed with a Visual Analogue Scale (VAS). RESULTS: Surveys were completed either by mail or follow-up telephone interview by 134 patients (71.6%). Average follow-up was 48 months (range, 24-72 months). Acute symptoms were reported at the following rates: ambulation difficulty, 50.7%; extended antibiotic usage, 7.5%; persistent drainage, 3.7%; wound dehiscence, 2.2%; and incision and drainage, 1.5%. The chronic symptom questionnaire demonstrated a high degree of satisfaction with the cosmetic result (92.5%). Pain at the donor site was reported by 26.1% of patients with a mean VAS score of 3.8 in 10, and 11.2% chronically use pain medication. Twenty-one patients (15.7%) reported abnormal sensations at the donor site, but only 5.2% reported discomfort with clothing. A unique functional assessment revealed current impairments at the following rates: ambulation, 12.7%; recreational activities, 11.9%; work activities, 9.7%; activities of daily living, 8.2%; sexual activity, 7.5%; and household chores, 6.7%. CONCLUSIONS: A large percentage of patients report chronic donor site pain after anterior ICBG donation, even when only a single-level ACDF procedure is performed. Moreover, long-term functional impairment can also be significant. Patients should be counseled regarding these potential problems, and alternative sources of graft material should be considered.
Authors:
Jeff S Silber; D Greg Anderson; Scott D Daffner; Brian T Brislin; J Martin Leland; Alan S Hilibrand; Alexander R Vaccaro; Todd J Albert
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Spine     Volume:  28     ISSN:  1528-1159     ISO Abbreviation:  Spine     Publication Date:  2003 Jan 
Date Detail:
Created Date:  2003-01-24     Completed Date:  2003-02-05     Revised Date:  2009-07-09    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  134-9     Citation Subset:  IM    
Affiliation:
Department of Orthopaedic Surgery, Long Island Jewish Medical Center, New Hyde Park, New York, USA. jeffsilber@msn.com
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MeSH Terms
Descriptor/Qualifier:
Activities of Daily Living
Acute Disease
Bone Transplantation / adverse effects*,  methods
Cervical Vertebrae / surgery
Chronic Disease
Diskectomy* / adverse effects
Female
Follow-Up Studies
Humans
Ilium / transplantation*
Male
Outcome Assessment (Health Care) / statistics & numerical data*
Pain, Postoperative / etiology
Postoperative Complications / etiology*
Questionnaires
Reoperation
Retrospective Studies
Spinal Fusion* / adverse effects
Surgical Wound Infection / etiology
Time
United States

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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