The patient-reported outcome of chronic pain after the harvest of anterior iliac bone for anterior cervical arthrodesis.
BACKGROUND
Anterior cervical fusion (ACF) with autologous iliac bone graft is a traditional surgical method, but high rate of chronic pain (30%) at the anterior iliac crest presents a considerable hindrance to harvesting iliac bone. The memory of acute pain may become fainter as time progresses, and the incidence of chronic pain may not be as high as previously reported. The primary objective was to show the patient-reported outcome of chronic pain in the anterior iliac crest.


METHODS
Telephone surveys were conducted for patients with single-level ACF (group-S; n=72; M:F=52:20; median age, 53years), multiple-level ACF (group-M; n=61; M:F=40:21; 56years) using autologous iliac bone, and single-level ACF with a stand-alone cage (group-C; n=53; M:F=38:15; 51years). Logistic regression analysis was performed to determine the risk factors, and the variables included group, age, gender, postoperative period and satisfaction with the surgical outcome.


RESULTS
There was no chronic pain in 87% of the patients, with no difference among the groups (p=0.52). During the acute postoperative period, patients remembered no pain in 38/72 (53%) patients of group-S, 25/61 (41%) of group-M and 42/53 (79%) of group-C (p<0.001). Female gender (p=0.027; OR, 2.68; 95% CI, 1.12-6.41) was the risk factor for chronic pain.


CONCLUSIONS
Iliac bone harvest may not cause chronic pain in 87% of patients, and the memory of acute pain was faded in 40-50% of patients. Female gender was a risk factor for chronic pain. This information should be considered before harvesting iliac bone.
Department of Neurosurgery, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-Gu, Seoul 03080, Republic of Korea; Department of Neurosurgery, Seoul National University Hospital, 101, Daehak-ro, Jongno-Gu, Seoul 03080, Republic of Korea; Clinical Research Institute, Seoul National University Hospital, 101, Daehak-ro, Jongno-Gu, Seoul 03080, Republic of Korea.
Chi Heon
CH
Kim
Department of Neurosurgery, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-Gu, Seoul 03080, Republic of Korea; Department of Neurosurgery, Seoul National University Hospital, 101, Daehak-ro, Jongno-Gu, Seoul 03080, Republic of Korea; Clinical Research Institute, Seoul National University Hospital, 101, Daehak-ro, Jongno-Gu, Seoul 03080, Republic of Korea; Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea. Electronic address: chungc@snu.ac.kr.
Chun Kee
CK
Chung
Medical Research Collaborating Center, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-Gu, Seoul 03080, Republic of Korea.
Yunhee
Y
Choi
Department of Integrative Plant Science, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul 06974, Republic of Korea.
Sun Tae
ST
Hwang
Department of Neurosurgery, Seoul National University Hospital, 101, Daehak-ro, Jongno-Gu, Seoul 03080, Republic of Korea.
Sung-Mi
SM
Kim
Department of Neurosurgery, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-Gu, Seoul 03080, Republic of Korea; Clinical Research Institute, Seoul National University Hospital, 101, Daehak-ro, Jongno-Gu, Seoul 03080, Republic of Korea; Department of Neurosurgery, Seoul National University Boramae Hospital, Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Republic of Korea.
Sung Bae
SB
Park
D000328:Adult; D000369:Aged, 80 and over; D016025:Bone Transplantation / Q000009:adverse effects*; D059350:Chronic Pain / Q000209:etiology*; D005260:Female; D006801:Humans; D007085:Ilium / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology*; D000071066:Patient Reported Outcome Measures; D014182:Transplantation, Autologous / Q000009:adverse effects*
Arthrodesis; Autografts; Cervical spine; Ilium; Pain; Surgery