title: Complications of posterior iliac crest bone grafting in spine surgery in children.
abstract: METHODS
  The perioperative and postoperative complications associated with harvesting posterior iliac crest bone graft in children were reviewed. A retrospective study was performed and a questionnaire interview conducted.
  
  
  OBJECTIVE
  To determine the morbidity associated with posterior iliac crest bone graft in children.
  
  
  BACKGROUND
  Iliac crest bone is commonly used as a source of bone graft in spine surgery. Although there are multiple reports of complications in adults, there are no reports in children.
  
  
  METHODS
  A retrospective chart review was performed of 214 consecutive children who underwent spinal fusion with posterior iliac crest bone graft from 1990 through 1996. An interview was conducted of 87 patients with normal mental status, predominantly those with idiopathic scoliosis with a minimum of 2 years' follow-up (mean, 55 months).
  
  
  RESULTS
  The review showed one (0.5%) instance of arterial injury in the sciatic notch. Two (1%) patients had infections, both of which resolved with a single irrigation and débridement. There was one documented instance of sacroiliac penetration that did not cause clinical problems. The chart review showed three (1.4%) instances of continued pain and one (0.5%) of numbness. By contrast to the few reports of pain in the chart review, responses to an interview of 87 patients showed 21 (24%) children reporting pain at the iliac crest site, with 13 (15%) reporting problems with daily activities. The self-reported pain, on a scale of 1 to 10, ranged from 1 to 10 with a mean of 4. Nonsteroidal anti-inflammatory drugs (NSAIDS) were taken by eight (9%) children for pain at the bone graft site. Five (6%) reported skin irritation, and 18 (20%) mentioned numbness surrounding the scar.
  
  
  CONCLUSIONS
  The perioperative rate of complications in iliac crest bone grafting in children is low (2%). The complication of pain (24%) and pain that is severe enough to interfere with daily activity (15%) is significant at a mean follow-up of more than 4 years. The true extent of pain and numbness after posterior iliac crest bone grafting in children was severely underreported in the medical records and may be underrecognized.
authors.affiliation: Department of Orthopaedic Surgery, Children's Hospital of Los Angeles, Los Angeles, California 90027, USA. Dskaggs@chla.usc.edu
authors.forename: D L
authors.initials: DL
authors.lastname: Skaggs
authors.forename: M A
authors.initials: MA
authors.lastname: Samuelson
authors.forename: J M
authors.initials: JM
authors.lastname: Hale
authors.forename: R M
authors.initials: RM
authors.lastname: Kay
authors.forename: V T
authors.initials: VT
authors.lastname: Tolo
mesh_terms: D000293:Adolescent; D000328:Adult; D016025:Bone Transplantation / Q000009:adverse effects / Q000523:psychology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007085:Ilium / Q000637:transplantation*; D017116:Low Back Pain / Q000523:psychology; D008297:Male; D011183:Postoperative Complications / Q000523:psychology; D012189:Retrospective Studies; D012600:Scoliosis / Q000523:psychology / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000523:psychology; D011795:Surveys and Questionnaires