Use of autologous bone graft in anterior cervical decompression: morbidity & quality of life analysis.
Affiliation
Department of Surgery, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland. helenheneghan@hotmail.comIssue Date
2009MeSH
AdultAged
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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Use of autologous bone graft in anterior cervical decompression: morbidity & quality of life analysis. 2009, 10:158 BMC Musculoskelet DisordJournal
BMC musculoskeletal disordersDOI
10.1186/1471-2474-10-158PubMed ID
20015365Abstract
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
enISSN
1471-2474ae974a485f413a2113503eed53cd6c53
10.1186/1471-2474-10-158
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