Research
Autologous bone from the iliac crest is commonly used for spinal fusion. However, its use is associated with significant donor site morbidity, especially pain. Reconstructive procedures of the iatrogenic defect have been investigated as a technique to alleviate these symptoms. The goal of this study was to assess the effects of reconstruction versus no reconstruction following iliac crest harvest in adults undergoing spine surgery.
1Department of Neurosurgery, Royal Prince Alfred Hospital; 2Faculty of Medicine, University of New South Wales; 3Department of Neurosurgery, St. Vincent’s Hospital; 4Department of Neurosurgery, Australian School of Advanced Medicine, Macquarie University Hospital; 5Department of Orthopaedics, Prince of Wales Hospital; and 6Department of Neurosurgery, Prince of Wales Hospital, Sydney, Australia
Summary
OBJECT
Autologous bone from the iliac crest is commonly used for spinal fusion. However, its use is associated with significant donor site morbidity, especially pain. Reconstructive procedures of the iatrogenic defect have been investigated as a technique to alleviate these symptoms. The goal of this study was to assess the effects of reconstruction versus no reconstruction following iliac crest harvest in adults undergoing spine surgery.
METHODS
The authors searched the Cochrane Central Register of Controlled Trials (The Cochrane Library 2011, Issue 4); MEDLINE (1948–Oct 2011); EMBASE (1947–Oct 2011); and the reference lists of articles. Randomized controlled trials (RCTs) or nonrandomized controlled trials (NRCTs) were included in the study. Two independent reviewers selected the studies, extracted data using a standardized collection form, and assessed for risk of bias.
RESULTS
Three RCTs (96 patients) and 2 NRCTs (82 patients) were included. These had a moderate to high risk of bias. The results suggest that iliac crest reconstruction may be useful in reducing postoperative pain, minimizing functional disability, and improving cosmesis. No pattern of other clinical, radiological, or resource outcomes was identified.
CONCLUSIONS
Although the available evidence is suboptimal, this systematic review supports the notion that iliac crest reconstruction following harvest for spinal fusion may reduce postoperative pain, minimize functional disability, and improve cosmesis. (http://thejns.org/doi/abs/10.3171/2012.3.SPINE11979)
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Keywords
systematic review, reconstructive surgery, bone substitute, bone transplantation, ilium, postoperative complication, spinal fusion
Abbreviations
CHA = coralline hydroxyapatite; ICM = inductive conductive matrix; NRCT = nonrandomized controlled trial; RCT = randomized controlled trial; SF-36 = 36-Item Short Form Health Survey; VAS = visual analog scale
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