TY - JOUR
T1 - Patients Cannot Reliably Distinguish the Iliac Crest Bone Graft Donor Site from the Contralateral Side after Lumbar Spine Fusion
T2 - A Patient-blinded Randomized Controlled Trial
AU - Lehr, A. Mechteld
AU - Oner, F. Cumhur
AU - Hoebink, Eric A.
AU - Kempen, Diederik H.R.
AU - Van Susante, Job L.C.
AU - Castelein, René M.
AU - Kruyt, Moyo C.
N1 - Funding Information:
The Department of Orthopaedic Surgery of the University Medical Center Utrecht received a restricted academic research grant from NuVasive Inc. to partially fund this investigator-initiated study.
Publisher Copyright:
© 2018 Wolters Kluwer Health, Inc. All rights reserved.
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2019/4/15
Y1 - 2019/4/15
N2 - Study Design.A multicenter, randomized, intrapatient controlled trial.Objective.This study investigated whether lumbar fusion patients blinded to the harvest site (A) can identify the iliac crest used for bone harvesting and (B) whether this iliac crest is more painful than the contralateral side.Summary of Background Data.Spinal fusion with iliac crest autograft is a frequently performed surgical procedure. A widely reported disadvantage of the harvesting procedure is potential donor site morbidity. This has driven the development of many bone graft substitutes. However, more recently the incidence and severity of donor site pain is debated, especially in lumbar fusion surgery.Methods.Ninety-two nontraumatic adult patients underwent a posterolateral (thoraco)lumbar fusion. Iliac crest bone graft was harvested unilaterally through the primary midline incision. At 6 weeks, 3 months, 6 months, and 1 year follow-up, patients were asked to identify the donor site and to rate pain in their back, left iliac crest and right iliac crest on a Visual Analogue Scale (VAS).Results.Ninety patients, 44 males and 46 females with a mean age of 54 years, were analyzed. The left/right distribution of the iliac crest donor site was 50/50 and 89% of the patients underwent a lumbar fusion below L3. Only 24% patients identified the harvest site correctly. Moreover, the VAS pain scores for the donor site and contralateral iliac crest did not differ and were at each timepoint lower than the scores for back pain.Conclusion.This study showed that, during the first year after lumbar fusion surgery via a single midline incision approach, patients could not reliably identify the iliac crest used for bone graft harvesting and this iliac crest was not more painful than the untouched contralateral iliac crest. Therefore, donor site pain should not be the main reason to use bone graft alternatives for lumbar spinal fusion.Level of Evidence: 2.
AB - Study Design.A multicenter, randomized, intrapatient controlled trial.Objective.This study investigated whether lumbar fusion patients blinded to the harvest site (A) can identify the iliac crest used for bone harvesting and (B) whether this iliac crest is more painful than the contralateral side.Summary of Background Data.Spinal fusion with iliac crest autograft is a frequently performed surgical procedure. A widely reported disadvantage of the harvesting procedure is potential donor site morbidity. This has driven the development of many bone graft substitutes. However, more recently the incidence and severity of donor site pain is debated, especially in lumbar fusion surgery.Methods.Ninety-two nontraumatic adult patients underwent a posterolateral (thoraco)lumbar fusion. Iliac crest bone graft was harvested unilaterally through the primary midline incision. At 6 weeks, 3 months, 6 months, and 1 year follow-up, patients were asked to identify the donor site and to rate pain in their back, left iliac crest and right iliac crest on a Visual Analogue Scale (VAS).Results.Ninety patients, 44 males and 46 females with a mean age of 54 years, were analyzed. The left/right distribution of the iliac crest donor site was 50/50 and 89% of the patients underwent a lumbar fusion below L3. Only 24% patients identified the harvest site correctly. Moreover, the VAS pain scores for the donor site and contralateral iliac crest did not differ and were at each timepoint lower than the scores for back pain.Conclusion.This study showed that, during the first year after lumbar fusion surgery via a single midline incision approach, patients could not reliably identify the iliac crest used for bone graft harvesting and this iliac crest was not more painful than the untouched contralateral iliac crest. Therefore, donor site pain should not be the main reason to use bone graft alternatives for lumbar spinal fusion.Level of Evidence: 2.
KW - Adult
KW - Aged
KW - Bone Transplantation/adverse effects
KW - Female
KW - Humans
KW - Ilium/transplantation
KW - Lumbar Vertebrae/surgery
KW - Male
KW - Middle Aged
KW - Pain, Postoperative/etiology
KW - Single-Blind Method
KW - Spinal Fusion
KW - Transplant Donor Site
KW - Transplantation, Autologous/adverse effects
UR - http://www.scopus.com/inward/record.url?scp=85064125657&partnerID=8YFLogxK
U2 - 10.1097/BRS.0000000000002882
DO - 10.1097/BRS.0000000000002882
M3 - Article
C2 - 30234805
AN - SCOPUS:85064125657
SN - 0362-2436
VL - 44
SP - 527
EP - 533
JO - Spine
JF - Spine
IS - 8
ER -