title: The Evaluation of Donor Site Pain After Harvest of Tricortical Anterior Iliac Crest Bone Graft for Spinal Surgery: A Prospective Study.
abstract: METHODS
  A prospective cohort.
  
  
  OBJECTIVE
  The aim of this study was to prospectively observe donor site pain, health-related quality-of-life outcomes, and complications following harvest of tricortical anterior iliac crest bone graft (AICBG) for anterior cervical discectomy and fusion (ACDF).
  
  
  BACKGROUND
  Persistent donor site pain from the anterior iliac crest has been reported to range between 2% and 40%. This morbidity has led surgeons to consider interbody alternatives for ACDF, which carry additional costs.
  
  
  METHODS
  We prospectively enrolled 50 patients from 2 tertiary care centers over the course of 1 year observing complications and patient-reported outcomes. Patients filled out SF-12 and numeric rating scale (NRS) for pain in the arm, neck, and donor site pre-operatively and at 1 week, 2 weeks, 6 weeks, 3 to 6 months, and 1 year postoperatively. Outcomes were compared with a control group undergoing ACDF with allograft or Polyether ether ketone cages at 1 year.
  
  
  RESULTS
  The mean ± SD donor site pain at 1 week was 5.6 ± 2.8 but decreased to 2.2 ± 2.4 at 6 weeks and 1.1 ± 1.8 at 1 year (P < 0.001). Including the 3 patients who were lost to follow-up, 10% of patients may have experienced persistent moderate or worse pain at 1 year. Linear regression analysis demonstrated that preoperative opioid use was an independent risk factor for increased donor site pain at 1 and 2 weeks (P < 0.05). There were no differences in outcomes at 1 year compared with the nonautograft group. There were 2 (4%) minor wound complications, both treated successfully with oral antibiotics.
  
  
  CONCLUSIONS
  Tricortical AICBG for ACDF is not associated with major complications and only 4% of patients (potentially, maximum of 10%) experienced moderate, persistent donor site pain at 1 year. There is no difference in health-related outcomes between patients who have autograft with those who did not at 1 year. Preoperative opioid use is associated with increased donor site pain within the first 2 weeks postoperatively but not in the long term. At 6 weeks postoperatively, patients can expect the majority of their donor site pain to be resolved.
  
  
  METHODS
  2.
authors.affiliation: *Department of Orthopaedics, Vanderbilt Orthopaedic Institute, Vanderbilt University School of Medicine, Nashville, TN†Texas Metroplex Institute for Sports Medicine and Orthopaedics, Arlington, TX‡Vanderbilt University School of Medicine, Nashville, TN§Oklahoma Sports, Science and Orthopaedics, Oklahoma City, OK||Department of Orthopaedics, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Sheyan J
authors.initials: SJ
authors.lastname: Armaghani
authors.forename: Jesse L
authors.initials: JL
authors.lastname: Even
authors.forename: Emily K
authors.initials: EK
authors.lastname: Zern
authors.forename: Brett A
authors.initials: BA
authors.lastname: Braly
authors.forename: James D
authors.initials: JD
authors.lastname: Kang
authors.forename: Clinton J
authors.initials: CJ
authors.lastname: Devin
mesh_terms: D000328:Adult; D016025:Bone Transplantation; D017586:Diskectomy; D005260:Female; D006801:Humans; D007085:Ilium / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010149:Postoperative Pain / Q000453:epidemiology*; D011446:Prospective Studies; D011788:Quality of Life; D013123:Spinal Fusion; D014019:Tissue Donors / Q000706:statistics & numerical data*; D020858:Tissue and Organ Harvesting / Q000009:adverse effects*