Donor site morbidity after anterior iliac crest bone harvest for single-level anterior cervical discectomy and fusion.
METHODS
This retrospective, questionnaire-based investigation evaluated iliac crest bone graft (ICBG) site morbidity in patients having undergone a single-level anterior cervical discectomy and fusion (ACDF) procedure performed by a single surgeon (T.J.A.).


OBJECTIVE
To evaluate acute and chronic problems associated with anterior ICBG donation, particularly long-term functional outcomes and impairments caused by graft donation.


BACKGROUND
Anterior cervical discectomy and fusion procedures frequently use autologous anterior ICBG to facilitate osseous union. Although autologous ICBG offers several advantages over alternative grafting materials, donor site morbidity can be significant. Acute and chronic complications of donor sites have been reported, yet there are currently no reports of long-term functional outcomes after autologous anterior ICBG donation after single-level ACDF.


METHODS
A questionnaire was mailed to 187 consecutive patients who were retrospectively identified to have undergone autologous anterior ICBG harvest for single-level ACDF between 1994 and 1998. The questionnaire divided items into symptomatic (acute and chronic) and functional assessments. Patients answered yes, no, or not applicable; pain was assessed with a Visual Analogue Scale (VAS).


RESULTS
Surveys were completed either by mail or follow-up telephone interview by 134 patients (71.6%). Average follow-up was 48 months (range, 24-72 months). Acute symptoms were reported at the following rates: ambulation difficulty, 50.7%; extended antibiotic usage, 7.5%; persistent drainage, 3.7%; wound dehiscence, 2.2%; and incision and drainage, 1.5%. The chronic symptom questionnaire demonstrated a high degree of satisfaction with the cosmetic result (92.5%). Pain at the donor site was reported by 26.1% of patients with a mean VAS score of 3.8 in 10, and 11.2% chronically use pain medication. Twenty-one patients (15.7%) reported abnormal sensations at the donor site, but only 5.2% reported discomfort with clothing. A unique functional assessment revealed current impairments at the following rates: ambulation, 12.7%; recreational activities, 11.9%; work activities, 9.7%; activities of daily living, 8.2%; sexual activity, 7.5%; and household chores, 6.7%.


CONCLUSIONS
A large percentage of patients report chronic donor site pain after anterior ICBG donation, even when only a single-level ACDF procedure is performed. Moreover, long-term functional impairment can also be significant. Patients should be counseled regarding these potential problems, and alternative sources of graft material should be considered.
Silber
Jeff S
JS
Department of Orthopaedic Surgery, Long Island Jewish Medical Center, New Hyde Park, New York, USA. jeffsilber@msn.com
Anderson
D Greg
DG
Daffner
Scott D
SD
Brislin
Brian T
BT
Leland
J Martin
JM
Hilibrand
Alan S
AS
Vaccaro
Alexander R
AR
Albert
Todd J
TJ
D000203:Activities of Daily Living; D000208:Acute Disease; D016025:Bone Transplantation / Q000009:adverse effects* / Q000379:methods; D002574:Cervical Vertebrae / Q000601:surgery; D002908:Chronic Disease; D017586:Diskectomy / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007085:Ilium / Q000637:transplantation*; D008297:Male; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010149:Postoperative Pain / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology*; D012086:Reoperation; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects; D013530:Surgical Wound Infection / Q000209:etiology; D011795:Surveys and Questionnaires; D013995:Time; D014481:United States