Departments of 1 Neurosurgery and.
J Neurosurg Spine. 2014 Oct;21(4):595-600. doi: 10.3171/2014.6.SPINE13902. Epub 2014 Jul 11.
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.
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).
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.
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.
大量的生物学研究旨在辅助腰椎融合手术中的骨愈合。髂嵴自体移植物常被认为是金标准，因为它具有骨传导性、骨诱导性和成骨性等重要特性。然而，移植物部位疼痛已被广泛报道为最常见的供体部位并发症。自体移植物部位疼痛导致许多公司开发了大量的骨移植延伸剂，但这些延伸剂的疗效有限。在手术同意过程中，许多患者要求外科医生避免采集自体移植物，因为有报道称这种移植物会引起疼痛并发症。作者试图通过简单地询问患者，当融合手术仅做一个皮肤切口时，他们是否知道哪个髂嵴被移植，来研究术后移植物部位的疼痛。
25 例患者在接受器械辅助腰椎融合手术时接受了髂嵴自体骨移植和同种异体骨重建。所有患者均通过同一皮肤切口、单独的筋膜切口采集自体移植物。在术后的不同时间点，患者被问及是否能分辨出哪个髂嵴被采集，如果能分辨出来，疼痛程度如何（10 分数字评分量表）。
大多数患者（64%）无法正确判断哪个髂嵴被采集。在 9 名能正确识别自体移植物侧别的患者中，有 7 名只是猜测。2 名能自信识别移植侧别的患者在休息时没有疼痛，活动时有轻度疼痛。1 名错误猜测自体移植物侧别的患者双侧骶髂关节退行性疼痛明显。
本研究结果表明，除非患者有单独的皮肤切口，否则在髂嵴自体骨移植和同种异体骨重建骨缺损后，无法清楚地定义其移植物部位。这项简单、易于复制的初步研究可以扩展为更大的、多机构的调查，以提供关于在脊柱融合中使用的理想、安全和具有成本效益的骨移植材料的更明确答案。
