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dc.contributor.authorHeneghan, Helen M
dc.contributor.authorMcCabe, John P
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
refterms.dateFOA2018-09-03T10:43:44Z
html.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.


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