Reconstruction versus no reconstruction of iliac crest defects following harvest for spinal fusion: a systematic review: A review

Caecum Rupture Secondary to Iliac Crest Bone Graft: A Case Report

Autogenous bone grafting is a common surgical method in orthopaedics. The anterior iliac crest is a common site for harvesting autologous bone grafts. There are many complications after iliac bone harvesting, and pain and discomfort at the donor site are the most common sequelae. However, intestinal rupture after iliac bone harvesting has not been reported. We report a case of caecum rupture in a 58-year-old male after harvesting bone from his iliac crest. After proper surgical repair, the patient was discharged from the ICU and his bowel function recovered. This serious complication of bone harvesting from the iliac crest prompted investigation of the technique of iliac crest harvesting and donor site reconstruction.

Bone defect filling with a novel rattan-wood based not-sintered hydroxyapatite and beta-tricalcium phosphate material (b.Bone™) after tricortical bone graft harvesting - A consecutive clinical case series of 9 patients

Harvesting of tricortical bone graft from the iliac crest is an integral part of bone defect reconstruction in orthopaedic surgery. There are several options for filling the iliac crest defect area to avoid hematoma, pain, hernias and cosmetic issues, including different gelatin-based and other alternative biomaterials. Recently, a novel rattan-wood based not-sintered hydroxyapatite and beta-tricalcium phosphate material (b.Bone™, GreenBone ORTHO S.p.A Faenza, Italy) was shown to promote bone healing in an experimental setting. The goal of the current work is to report clinical and radiographical outcomes of a consecutive case series of 9 patients with defect filling at the iliac crest with this novel scaffold biomaterial after tricortical bone graft harvesting with a minimum follow-up of 6 months. All 9 patients (8 male, 1 female) with an average age of 42.7 years (range: 18-76 years) had tricortical bone graft harvesting from the iliac crest for different reconstructive procedures at the extremities and received blocks of the biomaterial with an average size of 26.3 × 16.8 × 10 mm (length, height, width; range: 15 × 15 × 10 to 40 × 20 × 10 mm). Intraoperative handling of the biomaterial was easy and the blocks could be customized to the individual size of the defect with standard surgical instruments and were press-fitted into the defect. All 9 patients showed uneventful wound healing at the iliac crest and 7 patients reported no pain (VAS: 0) and two patients only mild pain (VAS:1 and VAS:3) after an average follow-up of 9.8 months (range: 6-16 months). There was no post-operative hematoma, surgical revision or other implant-related complications at the iliac crest. In all patients, good radiographical integration without dislocation of the implant and good bony integration was observed. The use of this novel biomaterial for iliac crest defect filling was associated with good clinical and radiographical outcomes after an average follow-up of 9.8 months.

Reconstruction of iliac crest defect after autogenous harvest with bone cement and screws reduces donor site pain

Background

The iliac crest is the most common autogenous bone graft donor site, although associated with postoperative pain, functional disability, cosmesis, morphology and surgical satisfaction. We assessed each aspect above by comparing iliac crest reconstruction with bone cement and screws following harvest with no reconstruction.

Methods

We evaluated patients who underwent large iliac crest harvesting, including ten patients who underwent iliac crest defect reconstruction with bone cement and cancellous screws (R group) and ten randomly matched patients without reconstruction (NR group) were evaluated prospectively in the same period. Local pain, cosmesis and other complications were assessed postoperatively at 1 week, 6 weeks, 3 months and 6 months.

Results

Pain, cosmesis and satisfaction of patients significantly differed between the two groups. The R group exhibited less complications and lower pain visual analogue scores at postoperative 1 week (p < 0.001), 6 weeks (p < 0.001) and 3 months (p < 0.01) but not at 6 months, at which time patients reported almost no pain. One patient reported pain for more than 1 year in the NR group. The R group exhibited better cosmesis, morphology and satisfaction than the NR group. In the NR group, one patient suffered pain when sitting up and another when wearing a belt.

Conclusion

Postoperative pain can be reduced and cosmesis can be improved through reconstructing the iliac crest defects after autogenous harvesting with bone cement and cancellous screws. The technique is simple, safe and easy to implement.

Modified Iliac Crest Reconstruction with Bone Cement for Reduction of Donor Site Pain and Morbidity after Open Wedge High Tibial Osteotomy: A Prospective Study

Purpose

This study was to determine the efficacy of iliac crest reconstruction using bone cement in reducing pain and morbidity at the donor site in patients undergoing open wedge high tibial osteotomy (OWHTO) with tricortical iliac crest autologous graft.

Materials and Methods

Thirty-three patients who underwent iliac crest reconstruction using polymethyl methacrylate (PMMA) bone cement (group A) and thirty patients who had no iliac crest reconstruction (group B) were enrolled in this study. All patients were evaluated for pain and functional disability related to graft harvesting using the pain and functional visual analogue scale (VAS) score during hospital stay and at 6 weeks, 3 months, and 6 months postoperatively.

Results

There was significant difference between the two groups in terms of pain and function. The pain VAS score was significantly lower in group A than group B during the first 2 weeks postoperatively (p=0.04) and the functional VAS score was also significantly lower in group A during the first 2 weeks postoperatively (p<0.001) in terms of breathing, sitting up from the supine position, and standing up with crutches from the sitting position.

Conclusions

Iliac crest donor site reconstruction using PMMA bone cement in patients undergoing OWHTO significantly decreased pain and improved function during the first 2 weeks postoperatively when compared to patients who underwent OWHTO without iliac crest reconstruction.

A retrospective study of iliac crest bone grafting techniques with allograft reconstruction: do patients even know which iliac crest was harvested? Clinical article

OBJECT

Considerable biological research has been performed to aid bone healing in conjunction with lumbar fusion surgery. Iliac crest autograft is often considered the gold standard because it has the vital properties of being osteoconductive, osteoinductive, and osteogenic. However, graft site pain has been widely reported as the most common donor site morbidity. Autograft site pain has led many companies to develop an abundance of bone graft extenders, which have limited proof of efficacy. During the surgical consent process, many patients ask surgeons to avoid harvesting autograft because of the reported pain complications. The authors sought to study postoperative graft site pain by simply asking patients whether they knew which iliac crest was grafted when a single skin incision was made for the fusion operation.

METHODS

Twenty-five patients underwent iliac crest autografting with allograft reconstruction during instrumented lumbar fusion surgery. In all patients the autograft was harvested through the same skin incision but with a separate fascial incision. At various points postoperatively, the patients were asked if they could tell which iliac crest had been harvested, and if so, how much pain did it cause (10-point Numeric Rating Scale).

RESULTS

Most patients (64%) could not correctly determine which iliac crest had been harvested. Of the 9 patients who correctly identified the side of the autograft, 7 were only able to guess. The 2 patients who confidently identified the side of grafting had no pain at rest and mild pain with activity. One patient who incorrectly guessed the side of autografting did have significant sacroiliac joint degenerative pain bilaterally.

CONCLUSIONS

Results of this study indicate the inability of patients to clearly define their graft site after iliac crest autograft harvest with allograft reconstruction of the bony defect unless they have a separate skin incision. This simple, easily reproducible pilot study can be expanded into a larger, multiinstitutional investigation to provide more definitive answers regarding the ideal, safe, and cost-effective bone graft material to be used in spinal fusions.