Reconstruction of Anterior Iliac Crest after Bone Graft Harvest Decreases Pain: A Randomized, Controlled Clinical Trial

Abstract

ABSTRACT OBJECTIVE: A substantial number of patients report persistent pain after graft harvest from the anterior iliac crest. There have been several retrospective case series published that suggest that iliac crest reconstruction using a variety of techniques may decrease graft site pain. This study, a randomized, controlled clinical trial at a university hospital, tested the hypothesis that reconstruction of the iliac crest will reduce graft harvest site pain. METHODS: A randomized, controlled clinical trial using the McGill Pain Inventory as the primary outcome measure was performed to evaluate the effect of anterior iliac crest reconstruction after graft harvest. Thirty patients who were treated with anterior cervical discectomy and fusion or cervical corpectomy and fusion with autologous iliac crest graft were randomized to one of two groups. Patients in Group 1 were treated with reconstruction of the iliac crest with commercially available tricalcium phosphate bone void filler after graft harvest. Patients in Group 2 were treated without graft site reconstruction. Graft site pain was assessed immediately after surgery, 6 weeks after surgery, and 3 months after surgery. RESULTS: Treatment groups were well matched with regard to patient age, sex, and smoking history. Although patients in each group reported persistent pain 6 weeks and 3 months after graft harvest, patients in the reconstruction group reported significantly less severe pain at 6 weeks and tended to have less pain at 3 months after surgery. CONCLUSION: Reconstruction of the iliac crest with tricalcium phosphate bone void filler significantly decreases the severity of postoperative pain 6 weeks after surgery.