Iliac crest bone graft harvest donor site morbidity [Neurosurgery Wiki]

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====== Iliac crest bone graft harvest donor site morbidity ======

A frequently reported complication of [[autologous bone graft]]ing from the [[iliac crest]] is post-operative pain at the donor site, which has been reported to result in up to 22% additional morbidity
((McConnell JR, Freeman BJ, Debnath UK, Grevitt MP, Prince HG, Webb JK. A
prospective randomized comparison of coralline hydroxyapatite with autograft in
cervical interbody fusion. Spine (Phila Pa 1976). 2003 Feb 15;28(4):317-23.
PubMed PMID: 12590203.
)).

Although a more elegant needle technique has reduced this percentage, at 2 weeks post-operatively 12% of patients still has persisting complaints of pain at the donor site 
((Bartels RH. Single-blinded prospective randomized study comparing open versus 
needle technique for obtaining autologous cancellous bone from the iliac crest.
Eur Spine J. 2005 Sep;14(7):649-53. Epub 2005 Feb 17. PubMed PMID: 15717189;
PubMed Central PMCID: PMC3489220.
)).

Other complications include wound hematoma, infection, pelvic fracture and nerve palsy at the donor site region
((Jacobs WC, Anderson PG, Limbeek J, Willems PC, Pavlov P. Single or
double-level anterior interbody fusion techniques for cervical degenerative disc 
disease. Cochrane Database Syst Rev. 2004 Oct 18;(4):CD004958. Review. Update in:
Cochrane Database Syst Rev. 2011;(1):CD004958. PubMed PMID: 15495130.
)).

An alternative to prevent this morbidity is the use of [[allograft]]s 
((Savolainen S, Rinne J, Hernesniemi J. A prospective randomized study of
anterior single-level cervical disc operations with long-term follow-up: surgical
fusion is unnecessary. Neurosurgery. 1998 Jul;43(1):51-5. PubMed PMID: 9657188.
))
((Vaccaro AR, Singh K, Haid R, Kitchel S, Wuisman P, Taylor W, Branch C, Garfin 
S. The use of bioabsorbable implants in the spine. Spine J. 2003
May-Jun;3(3):227-37. Review. PubMed PMID: 14589204.
))
((Young WF, Rosenwasser RH. An early comparative analysis of the use of fibular 
allograft versus autologous iliac crest graft for interbody fusion after anterior
cervical discectomy. Spine (Phila Pa 1976). 1993 Jul;18(9):1123-4. PubMed PMID:
8362317.
)).

Unfortunately, allografts are expensive, incorporate more slowly and carry the potential risk of disease transmission
((Jacobs WC, Anderson PG, Limbeek J, Willems PC, Pavlov P. Single or
double-level anterior interbody fusion techniques for cervical degenerative disc 
disease. Cochrane Database Syst Rev. 2004 Oct 18;(4):CD004958. Review. Update in:
Cochrane Database Syst Rev. 2011;(1):CD004958. PubMed PMID: 15495130.
)).