Use of autologous bone graft in anterior cervical decompression: morbidity & quality of life analysis.

Hdl Handle:
http://hdl.handle.net/10147/95636
Title:
Use of autologous bone graft in anterior cervical decompression: morbidity & quality of life analysis.
Authors:
Heneghan, Helen M; McCabe, John P
Affiliation:
Department of Surgery, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland. helenheneghan@hotmail.com
Citation:
Use of autologous bone graft in anterior cervical decompression: morbidity & quality of life analysis. 2009, 10:158 BMC Musculoskelet Disord
Journal:
BMC musculoskeletal disorders
Issue Date:
2009
URI:
http://hdl.handle.net/10147/95636
DOI:
10.1186/1471-2474-10-158
PubMed ID:
20015365
Abstract:
BACKGROUND: Autologous iliac crest graft has long been the gold standard graft material used in cervical fusion. However its harvest has significant associated morbidity, including protracted postoperative pain scores at the harvest site. Thus its continued practice warrants scrutiny, particularly now that alternatives are available. Our aims were to assess incidence and nature of complications associated with iliac crest harvest when performed in the setting of Anterior Cervical Decompression (ACD). Also, to perform a comparative analysis of patient satisfaction and quality of life scores after ACD surgeries, when performed with and without iliac graft harvest. METHODS: All patients who underwent consecutive ACD procedures, with and without the use of autologous iliac crest graft, over a 48 month period were included (n = 53). Patients were assessed clinically at a minimum of 12 months postoperatively and administered 2 validated quality of life questionnaires: the SF-36 and Cervical Spine Outcomes Questionnaires (Response rate 96%). Primary composite endpoints included incidence of bone graft donor site morbidity, pain scores, operative duration, and quality of life scores. RESULTS: Patients who underwent iliac graft harvest experienced significant peri-operative donor site specific morbidity, including a high incidence of pain at the iliac crest (90%), iliac wound infection (7%), a jejunal perforation, and longer operative duration (285 minutes vs. 238 minutes, p = 0.026). Longer term follow-up demonstrated protracted postoperative pain at the harvest site and significantly lower mental health scores on both quality of life instruments, for those patients who underwent autologous graft harvest CONCLUSION: ACD with iliac crest graft harvest is associated with significant iliac crest donor site morbidity and lower quality of life at greater than 12 months post operatively. This is now avoidable by using alternatives to autologous bone without compromising clinical or technical outcome.
Language:
en
MeSH:
Adult; Aged; Bone Substitutes; Bone Transplantation; Decompression, Surgical; Delivery of Health Care; Female; Humans; Ilium; Male; Middle Aged; Outcome Assessment (Health Care); Pain, Postoperative; Postoperative Complications; Quality of Life; Spinal Cord Compression; Spinal Fusion; Spondylosis; Surgical Wound Infection; Transplantation, Autologous; Treatment Outcome
ISSN:
1471-2474

Full metadata record

DC FieldValue Language
dc.contributor.authorHeneghan, Helen Men
dc.contributor.authorMcCabe, John Pen
dc.date.accessioned2010-04-06T10:14:24Z-
dc.date.available2010-04-06T10:14:24Z-
dc.date.issued2009-
dc.identifier.citationUse of autologous bone graft in anterior cervical decompression: morbidity & quality of life analysis. 2009, 10:158 BMC Musculoskelet Disorden
dc.identifier.issn1471-2474-
dc.identifier.pmid20015365-
dc.identifier.doi10.1186/1471-2474-10-158-
dc.identifier.urihttp://hdl.handle.net/10147/95636-
dc.description.abstractBACKGROUND: Autologous iliac crest graft has long been the gold standard graft material used in cervical fusion. However its harvest has significant associated morbidity, including protracted postoperative pain scores at the harvest site. Thus its continued practice warrants scrutiny, particularly now that alternatives are available. Our aims were to assess incidence and nature of complications associated with iliac crest harvest when performed in the setting of Anterior Cervical Decompression (ACD). Also, to perform a comparative analysis of patient satisfaction and quality of life scores after ACD surgeries, when performed with and without iliac graft harvest. METHODS: All patients who underwent consecutive ACD procedures, with and without the use of autologous iliac crest graft, over a 48 month period were included (n = 53). Patients were assessed clinically at a minimum of 12 months postoperatively and administered 2 validated quality of life questionnaires: the SF-36 and Cervical Spine Outcomes Questionnaires (Response rate 96%). Primary composite endpoints included incidence of bone graft donor site morbidity, pain scores, operative duration, and quality of life scores. RESULTS: Patients who underwent iliac graft harvest experienced significant peri-operative donor site specific morbidity, including a high incidence of pain at the iliac crest (90%), iliac wound infection (7%), a jejunal perforation, and longer operative duration (285 minutes vs. 238 minutes, p = 0.026). Longer term follow-up demonstrated protracted postoperative pain at the harvest site and significantly lower mental health scores on both quality of life instruments, for those patients who underwent autologous graft harvest CONCLUSION: ACD with iliac crest graft harvest is associated with significant iliac crest donor site morbidity and lower quality of life at greater than 12 months post operatively. This is now avoidable by using alternatives to autologous bone without compromising clinical or technical outcome.-
dc.language.isoenen
dc.subject.meshAdult-
dc.subject.meshAged-
dc.subject.meshBone Substitutes-
dc.subject.meshBone Transplantation-
dc.subject.meshDecompression, Surgical-
dc.subject.meshDelivery of Health Care-
dc.subject.meshFemale-
dc.subject.meshHumans-
dc.subject.meshIlium-
dc.subject.meshMale-
dc.subject.meshMiddle Aged-
dc.subject.meshOutcome Assessment (Health Care)-
dc.subject.meshPain, Postoperative-
dc.subject.meshPostoperative Complications-
dc.subject.meshQuality of Life-
dc.subject.meshSpinal Cord Compression-
dc.subject.meshSpinal Fusion-
dc.subject.meshSpondylosis-
dc.subject.meshSurgical Wound Infection-
dc.subject.meshTransplantation, Autologous-
dc.subject.meshTreatment Outcome-
dc.titleUse of autologous bone graft in anterior cervical decompression: morbidity & quality of life analysis.en
dc.contributor.departmentDepartment of Surgery, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland. helenheneghan@hotmail.comen
dc.identifier.journalBMC musculoskeletal disordersen

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