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

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    Authors
    Heneghan, Helen M
    McCabe, John P
    Affiliation
    Department of Surgery, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland. helenheneghan@hotmail.com
    Issue Date
    2009
    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
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    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
    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
    ISSN
    1471-2474
    ae974a485f413a2113503eed53cd6c53
    10.1186/1471-2474-10-158
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