Abstract
We studied 117 adult patients undergoing posterior lumbar spinal fusion and instrumentation using bone grafts from the iliac crest between February 1999 and January 2001. All patients had degenerative disease of the lumbar spine, and all were operated upon by the same surgeon. Patients were randomized to have the iliac bone graft harvested either through a separate incision (traditional approach) or utilizing the same midline incision as used for the spinal surgery (intrafascial approach). Total volume of harvested graft, blood loss, pain, complications, and patient satisfaction were evaluated with a minimum of 2-year follow-up. There were no infections. The average volume of harvested bone was 17.2 cc versus 14.7 cc; total blood loss was 168 cc versus 96 cc; total complication rate was 20% versus 8%, and overall satisfaction rate was 81% versus 96%, respectively. The intrafascial graft harvesting technique minimizes morbidity and increases patient satisfaction compared with the traditional bone harvesting technique.
Résumé
Nous avons étudié 117 malades adultes traités par arthrodèse lombaire postérieure avec instrumentation et greffe iliaque entre février 1999 et janvier 2001. Tous les malades avaient une maladie dégénérative de la colonne vertébrale lombaire et tous ont été opérés par le même chirurgien. Les malades ont été randomisés pour avoir la greffe iliaque prélevée par une incision séparée (approche traditionnelle) ou par la même incision médiane habituellement utilisée pour la chirurgie vertébrale (approche intrafasciale). Le volume totale de greffe prélevée, la perte de sang, les douleur, les complications et la satisfaction des malades ont été évalué avec un minimum de suivi de deux années. Il n’y avait pas d’infection. Le volume moyen d’os prélevé était 17,2 cc contre 14,7 cc; la perte totale de sang était 168 cc contre 96 cc; le taux de complications était 20% contre 8% et le taux de la satisfaction était 81% contre 96% respectivement. La technique de prélèvement intrafasciale minimise la morbidité et augmente la satisfaction du malade comparée à la technique traditionnelle de prélèvement.
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References
- 1.Ahlmann E, Patzakis M, Roidis N, Shepherd L, Holtom P. Comparison of anterior and posterior iliac crest bone grafts in terms of harvest-site morbidity and functional outcomes. J Bone Joint Surg Am. 2002;84:716–720. doi: 10.1302/0301-620X.84B5.12571. [DOI] [PubMed] [Google Scholar]
- 2.Arrington ED, Smith WJ, Chambers HG, Bucknell AL, Davino NA. Complications of iliac crest bone graft harvesting. Clin Orthop. 1996;329:300–309. doi: 10.1097/00003086-199608000-00037. [DOI] [PubMed] [Google Scholar]
- 3.Banwart JC, Asher MA, Hassanein RS. Iliac crest bone graft harvest donor site morbidity. A statistical evaluation. Spine. 1995;20:1055–1060. doi: 10.1097/00007632-199505000-00012. [DOI] [PubMed] [Google Scholar]
- 4.Behairy Y, Al-sebai W. A modified technique for harvesting full-thickness iliac crest bone graft. Spine. 2001;26:695–697. doi: 10.1097/00007632-200103150-00028. [DOI] [PubMed] [Google Scholar]
- 5.Burnstein FD, Simms C, Cohen SR, Work F, Paschal M. Iliac crest bone graft harvesting techniques: a comparison. Plast Reconstr Surg. 2000;105:34–39. doi: 10.1097/00006534-200001000-00006. [DOI] [PubMed] [Google Scholar]
- 6.Fernyhough JC, Schimandle JJ, Weigel MC, Edwards CC, Levine AM. Chronic donor site pain complicating bone graft harvesting from the posterior iliac crest for spinal fusion. Spine. 1992;17:1474–1480. doi: 10.1097/00007632-199212000-00006. [DOI] [PubMed] [Google Scholar]
- 7.Goulet JA, Senunas LE, DeSilva GL, Greenfield ML. Autogenous iliac crest bone graft. Complications and functional assessment. Clin Orthop. 1997;339:76–81. doi: 10.1097/00003086-199706000-00011. [DOI] [PubMed] [Google Scholar]
- 8.Hu R, Hearn T, Yang J. Bone graft harvest site as a determinant of iliac crest strength. Clin Orthop. 1995;310:252–256. [PubMed] [Google Scholar]
- 9.Hutchinson MR, Dall BE. Midline fascial splitting approach to the iliac crest for bone graft. A new approach. Spine. 1994;19:62–66. doi: 10.1097/00007632-199401000-00013. [DOI] [PubMed] [Google Scholar]
- 10.Kurz LT, Garfin SR, Booth RE. Harvesting autogenous iliac bone grafts. A review of complications and techniques. Spine. 1989;14:1324–1331. doi: 10.1097/00007632-198912000-00009. [DOI] [PubMed] [Google Scholar]
- 11.Mirovsky Y, Neuwirt MG. Comparison between the outer table and intracortical methods of obtaining autogenous bone graft from the iliac crest. Spine. 2000;25:1722–1725. doi: 10.1097/00007632-200007010-00018. [DOI] [PubMed] [Google Scholar]
- 12.Robertson PA, Wray AC. Natural history of posterior iliac crest bone graft donation for spinal surgery: a prospective analysis of morbidity. Spine. 2001;26:1473–1476. doi: 10.1097/00007632-200107010-00018. [DOI] [PubMed] [Google Scholar]
- 13.Skaggs DL, Samuelson MA, Hale JM, Kay RM, Tolo VT. Complications of posterior iliac crest bone grafting in spine surgery in children. Spine. 2000;25:2400–2402. doi: 10.1097/00007632-200009150-00021. [DOI] [PubMed] [Google Scholar]
- 14.Younger EM, Chapman MW. Morbidity at bone graft donor sites. J Orthop Trauma. 1989;3:192–195. doi: 10.1097/00005131-198909000-00002. [DOI] [PubMed] [Google Scholar]