title: A retrospective study of iliac crest bone grafting techniques with allograft reconstruction: do patients even know which iliac crest was harvested? Clinical article.
abstract: OBJECTIVE
  Considerable biological research has been performed to aid bone healing in conjunction with lumbar fusion surgery. Iliac crest autograft is often considered the gold standard because it has the vital properties of being osteoconductive, osteoinductive, and osteogenic. However, graft site pain has been widely reported as the most common donor site morbidity. Autograft site pain has led many companies to develop an abundance of bone graft extenders, which have limited proof of efficacy. During the surgical consent process, many patients ask surgeons to avoid harvesting autograft because of the reported pain complications. The authors sought to study postoperative graft site pain by simply asking patients whether they knew which iliac crest was grafted when a single skin incision was made for the fusion operation.
  
  
  METHODS
  Twenty-five patients underwent iliac crest autografting with allograft reconstruction during instrumented lumbar fusion surgery. In all patients the autograft was harvested through the same skin incision but with a separate fascial incision. At various points postoperatively, the patients were asked if they could tell which iliac crest had been harvested, and if so, how much pain did it cause (10-point Numeric Rating Scale).
  
  
  RESULTS
  Most patients (64%) could not correctly determine which iliac crest had been harvested. Of the 9 patients who correctly identified the side of the autograft, 7 were only able to guess. The 2 patients who confidently identified the side of grafting had no pain at rest and mild pain with activity. One patient who incorrectly guessed the side of autografting did have significant sacroiliac joint degenerative pain bilaterally.
  
  
  CONCLUSIONS
  Results of this study indicate the inability of patients to clearly define their graft site after iliac crest autograft harvest with allograft reconstruction of the bony defect unless they have a separate skin incision. This simple, easily reproducible pilot study can be expanded into a larger, multiinstitutional investigation to provide more definitive answers regarding the ideal, safe, and cost-effective bone graft material to be used in spinal fusions.
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Pirris
authors.forename: Eric W
authors.initials: EW
authors.lastname: Nottmeier
authors.forename: Sherri
authors.initials: S
authors.lastname: Kimes
authors.forename: Michael
authors.initials: M
authors.lastname: O'Brien
authors.forename: Gazanfar
authors.initials: G
authors.lastname: Rahmathulla
mesh_terms: D000328:Adult; D064591:Allografts; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D006801:Humans; D007085:Ilium / Q000000981:diagnostic imaging / Q000637:transplantation*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology*; D010865:Pilot Projects; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods*; D014057:Tomography, X-Ray Computed; D060053:Transplant Donor Site / Q000000981:diagnostic imaging; D016896:Treatment Outcome
keywords: NRS = Numeric Rating Scale; autograft; bony extender; iliac crest bone graft; lumbar fusion; spinal arthrodesis; technique