Iliac crest bone graft harvest donor site morbidity. A statistical evaluation.
This paper published in 1995 is a case series of 261 patients that have had either posterior or anterior iliac crest harvesting for spinal fusion. With current utilization of bone graft substitutes including bone marrow aspiration and BMP, many of the more recently trained spine surgeons may not have had the experience of dealing with complications and complaints associated with iliac crest grafting. On the other hand, longer term data may still demonstrate the benefit of ICBG over more “modern” options.
Dr. Banwart quantified the ICBG complications of one seasoned spinal fusion specialist. While the original group of patients studied numbered 261, data from only 180 patients were used for the calculations. This paper certainly added knowledge of rates of complications of one surgeon. The loss of follow-up and rationale for exclusion caused the paper to have a poor score by our standards.
The discussion on changes to the techniques in the latter group of patients add some pearls of wisdom on how to avoid ICBG complication. The data does not reflect if there was any difference in the complication rates.
The study concludes major intra operative complications are rare (there were none) and that major post-operative complications (10% of the included patients) were related to wound issues and cosmetic appearance. Minor complications were more common and mostly were associated with transient pain and numbness.
In general, this was an informative retrospective look at one surgeon’s experience.
Since the publishing of this paper in 1995, others have tried to add information on the effects of ICBG. Most notably, in 2014, Gruskay et al (Spine Vol 39, issue 20) published a paper comparing the results of patients who did and did not have ICBG. This study reviewed data on patients who underwent spinal fusions 2010 to 2012. Interestingly less than 6% of these patients had ICBG. When the groups were retrospectively reviewed, the ICBG patients was an increased rate of blood transfusion, longer operative time, and a longer length of stay. There was no increases in readmissions rates. As this was a study on short term effects (only followed to post op day 30), there was no comment on any long term outcome issues such as clinical improvement, nonunion rates, etc.
While the Gruskay paper was an important look at the short term ramifications of the use of ICBG, perhaps a longer term follow-up period as well as statistical analysis on the specific reasons for ICBG vs non-ICBG will serve to identify the true long term morbidities and advantages/disadvantages of ICBG.