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Abstract
Study Design
A comparative retrospective study between those who have and have not undergone donor site reconstruction after thoracolumbar spinal anterior interbody fusion using an auto-iliac bone graft.
Objectives
To determine the efficacy of iliac reconstruction in reducing iliac donor site morbidity.
Summary of Literature Review
An autogenous bone graft harvested from the iliac crest is still the gold standard for spinal anterior interbody fusion. However, defects of a significant size often remain in the donor site, which may cause pain, pelvic instability and cosmetic deformity etc. Iliac donor site reconstruction with bone cement is one of the methods for reducing the donor site morbidity, with a relatively easy technique.
Materials and Methods
A review of patients who underwent iliac bone graft harvesting, with or without reconstruction, by a single orthopaedic surgeon was conducted. The iliac donor site morbidity, at least one after remote surgery was compared in those who had and had not undergone iliac reconstruction. All patients were evaluated by an independent observer. During a two and half year period, 61 patients met the inclusion criteria. Twenty-three patients underwent iliac donor site reconstruction with bone cement and 9 with auto rib bone reconstruction, while the remaining 29 had no donor site reconstruction. Patients were asked to assess the duration and severity of their donor site pain, using a visual analogue scale (VAS), and other morbidity, such as cosmetic deformity.
REFERENCES
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Figures and Tables%
Fig. 1.
(A) Standing KUB and L-S lateral radiograph of 52-year-old female patient with spondylolisthesis L4. (B) Postop radiograph of same patient, iliac donor site was reconstructed with bone cement. (C) Followup radiograph (14 months after operation) shows firm cement fixation in the iliac donor site.
Fig. 2.
(A) Standing KUB and L-S lateral radiograph of 49-year-old female patient with L5 spondylolisthesis. (B) Postop radiograph of same patient, iliac donor site was not reconstructed. (C) Followup radiograph (18 months after operation) shows large bone defect at the iliac donor site.
Table 2.
Duration of donor site pain
| Iliac reconstruction∗ | Non-reconstruction† | |
|---|---|---|
| Less than 6 months (PO∮) | 13 | 9 |
| 6~12 months | 5 | 6 |
| More than 12 months | 3 | 9 |
| Total‡ | 21 | 24 |
Table 3.
Frequency of donor site pain
| Iliac reconstruction | Non-reconstruction | |
|---|---|---|
| Rare | 1 | 1 |
| Seldom | 10 | 4 |
| Occasional | 6 | 13 |
| Frequent | 3 | 4 |
| Continuous | 1 | 2 |
| Total‡ | 21 | 24 |
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