Abstract
The objective of this cohort study—conducted at a regional trauma unit in southern Ontario, Canada—was to review the imaging history of open-section, iliac-wing bone graft donor sites in lumbar fusion patients. Intervention entailed review of available X-ray and CT scan images for all patients undergoing lumbar fusion with iliac autograft in the senior author’s practice over a 4-year period. Outcome was radiographic confirmation of the absence of bony reconstitution at the iliac harvest site. Of 239 primary fusions performed, 209 complete imaging records were available for review. The images of a further 20 patients who had surgery with the senior author prior to the study period and who presented at the office in the first half of 2000 were also assessed. All cases showed persistence of the iliac donor harvest site defect. Only minimal marginal sclerosis to suggest attempted remodeling was observed. We conclude that iliac-wing bone graft donor sites do not remodel. Given that iliac harvesting is known to increase strain in the pelvis, and that lumbosacral stabilization increases stress in the pelvis, permanent deficiency of iliac bone stock at donor harvest site may be a factor in both primary donor site pain and the observed high frequency of this problem in lumbosacral fusion patients.
Similar content being viewed by others
References
Colterjohn N, Bednar DA (1998) Procurement of iliac bone graft from the iliac crest: An operative approach with decreased morbidity. J Bone Joint Surg Am 79:756–760
Coventry MB, Tapper EM (1972) Pelvic instability: a consequence of removing iliac bone for grafting. J Bone Joint Surg Am 54(1):83–100
Ebraheim NA, Elgafy H, Semaan HB (2000) Computed tomographic findings in patients with persistent sacroiliac pain after posterior iliac graft harvesting Spine 25(16):2047–2051
Fernando TL, Kim SS, Mohler DG (1999) Complete pelvic ring failure after posterior iliac bone graft harvesting. Spine 24(20):2101–2104
Finkemeier CG (2002). Bone-grafting and bone-graft substitutes. J Bone Joint Surg Am 84:454–464
Frymoyer JW, Howe J, Kuhlmann D (1978) The long-term effects of spinal fusion on the sacroiliac joint and ilium. Clin Orthop 134:196–201
Goulet JA, Senunas LE, DeSilva GL, Greenfield ML (1997) Autogenous iliac crest bone graft. Complications and functional assessment. Clin Orthop 339:76–81
Guha SC, Poole MD (1983) Stress fracture of the iliac bone with subfascial femoral neuropathy: unusual complications at a bone graft donor site: Case report. Br J Plast Surg 36:305–306
Hu RW, Bohlmann HH (1994) Fracture at the iliac bone graft harvest site following fusion of the spine. Clin Orthop 309:208–213
Kuhn DA, Moreland MS (1986) Complications following iliac crest bone grafting. Clin Orthop 209:224–226
Lee CK (1988) Accelerated degeneration of the segment adjacent to a lumbar fusion. Spine 13(3):375–377
Lehman TR, Spratt KF, Tozzi JE et al (1997) Long-term follow-up of lower lumbar fusion patients. Spine 12(2):97–104
Lichtblau S (1962) Dislocation of the sacroiliac joint: A complication of bone grafting. J Bone Joint Surg Am 44(1):193–198
Medige J, Mindell ER, Doolittle T (1982) Remodeling of large, persistent bone defects. Clin Orthop 169:275–290
Mendenhall S (1999) Spinal surgery update. Orthopedic Network News (Mendenhall Associates, 1500 Cedar Bend Drive, Ann Arbor, MI 48105, USA) 10(4):1
Mirovsky Y, Neuwirth MG (2000) Comparison between the outer table and intracortical methods of obtaining autologous bone graft from the iliac crest. Spine 25(13):1722–1725
Rhanjee R, Wood KB, Wentorf FA (1998) Effect of lumbar and lumbosacral instrumentation on strains on the pelvis. In: Proceedings of the North American Spine Society, 13th Annual Meeting, San Francisco. North American Spine Society, pp 206–207
Robertson PA, Wray AC (2001) Natural history of posterior iliac crest bone graft donation for spinal surgery: a prospective analysis of morbidity. Spine 26(13):1473–1476
Varga E, Hu R, Hearn TC, Woodside T, Yang JP (1996) Biomechanical analysis of hemipelvic deformation after corticospongious bone graft harvest from the posterior iliac crest. Spine 21(13):1494–1499
Violas P, Chapuis M, Bracq H (2004) Local autograft bone in the surgical management of adolescent idiopathic scoliosis. Spine 29(2):189–192
Wang MY, Levi AD, Shah S, Green B (2002) Polylactic acid mesh reconstitution of the anterior iliac crest after bone harvesting reduces postoperative pain after anterior cervical fusion surgery. Neurosurgery 51(2):413–416
Wood KB, Schendel MJ, Ogilvie JW, Braun J, Major MC, Malcolm JR (1996) Effect of sacral and iliac instrumentation on strains in the pelvis. Spine 21(10):1185–1191
Wood KB, Geissele AE, Ogilvie JW (1996) Pelvic fractures after long lumbosacral fusions. Spine 21(11):1357–1362
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bednar, D.A., Al-Tunaib, W. Failure of reconstitution of open-section, posterior iliac-wing bone graft donor sites after lumbar spinal fusion. Observations with implications for the etiology of donor site pain. Eur Spine J 14, 95–98 (2005). https://doi.org/10.1007/s00586-004-0769-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-004-0769-2