Pain From Bone Graft: Is It Overestimated?The best material to use for spinal fusion is autologous bone from the iliac crest. Autologous means it is harvested from the person who needs it. Using your own bone chips is safer and costs less than getting donor bone from a bone bank. Bone from the iliac crest is easy to harvest.
The major downfall with this type of bone graft material is the pain some patients experience at the donor site. It can be a bigger problem than the spinal fusion operation.
In this study, researchers from the Netherlands take a closer look at pain levels in patients who use their own bone grafts. They compared pain after the operation for patients who had a high fusion with patients who had a low fusion.
High fusion included patients with spinal fusion anywhere between T2 and L2. Low fusion was done anywhere from L3 down. Fusion was done in all patients for traumatic spinal fractures that were treated surgically.
The graft was taken from the posterior iliac crest. The iliac crest is the top, curved part of the pelvic bone. Taking the graft from the posterior part of the crest means it comes from the back instead of the front of the bone. This is located close to the vertebrae of the spine.
They found that the patients who had the spinal fusion close to the site of the donor site were the most likely to report pain up to two years later. Almost 41 per cent of this group reported chronic pain at the donor site. They also had the most severe pain. Patients who had a spinal fusion in the high fusion group had the lowest incidence (14 per cent) of chronic pain from the donor site.
The authors suggest that it may be difficult to tell the difference between donor site pain and pain from the spinal fusion. This is especially true when they are close together in the low back area. Reports from previous studies of donor site pain may be overestimated. The fusion level and its relation to the donor site must be taken into account for a more accurate picture.
Diyar Delawi, MD, et al. The Incidence of Donor Site Pain After Bone Graft Harvesting from the Posterior Iliac Crest May Be Overestimated. In Spine. August 1, 2007. Vol. 32. No. 17. Pp. 1865-1868.
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