Prospective study of iliac crest bone graft harvest site pain and morbidity

Mesenchymal stem cells derived from vertebrae (vMSCs) show best biological properties

“…Autologous bone graft has been considered the gold standard for spine fusion procedures because of its osteogenic, osteoinductive and osteoconductive ability. However, its use is associated with significant disadvantages including donor site pain, increased operative time, insufficient availability, and nonunion post-lumbar fusion [8]. Allograft bone has been the most widely used substitute to avoid the complications of donor site morbidity, but it has increased risks of infection and rejection and poor osteoinductive properties [9].…”

The efficacy of porous hydroxyapatite bone chip as an extender of local bone graft in posterior lumbar interbody fusion

“…From the available options of graft choice, only autogenous bone graft, possesses all these three properties. However, it is too variable in quality and quantity according to each individual patient, furthermore it can accompany the morbidity of the donor site including pain, hematoma, infection, fracture and neurovascular injury resulting from procedure of harvest [7][8][9][10].…”

“…To overcome these problems related with mechanical properties of graft, cages were developed and used in combination with autologous cancellous bone from iliac crest [4,5]. Though autologous iliac crest graft became a gold-standard material for spinal fusion with fusion rate up to 98.9% [6], the morbidities from the donor site including pain, hematoma, infection, fracture and neurovascular injury resulting from the procedure of harvest let patients and surgeons hesitate to accept it as a primary choice for graft material [7][8][9][10]. Recently, for short level fusion of lumbar spine, local decompressed bone without supplementary graft material was reported to be enough to get satisfactory result [11,12].…”

Iliac crest bone grafting: raising awareness of a common pitfall

“…The iliac crest is the 'gold standard' source of bone graft and is considered a routine procedure in orthopaedic practice. Despite this familiarity, there is a high degree of morbidity associated with the procedure, with postoperative pain affecting 16.5-40 % of patients and major complications such as vascular injury, nerve injury, fracture and hernias reported in 2.4-8.6 % of cases [2,3]. It is therefore vital that patients are appropriately counselled and consented for this potentially risky procedure.…”

“…Only 20 % of records were acceptable, with 34 % neglecting to mention the side from which the graft was taken. We have since implemented ICBG operative templates in a computerised system that can be easily incorporated into a patient's electronic operative notes and amended according to the specifics of the patient's procedure.The complications of ICBG harvesting have been shown to cause significant limitations to patient activity, with one study showing that 12-14 % struggle with household and recreational activities and 5.2 % struggle with employment at one year follow-up [3]. Surgical trainees are often involved in consenting patients and documenting operative notes, and they need to regard the ICBG harvest as a separate procedure in its own right; indeed trainee operative logbooks reflect this by listing ICBG as a stand-alone procedure.…”