Morbidity of Iliac Crest Bone Graft Harvesting in Adolescent Deformity Surgery

Purpose: This study was performed to evaluate post-operative morbidity of the Iliac Crest Bone Graft (IBCG) site in patients that underwent surgical correction for Adolescent Idiopathic Scoliosis (AIS) and Scheuermann’s Kyphosis.

Methods: Fifty-nine patients were evaluated prospectively with a minimum of one-year post-operative followup. Data was collected over a 10-month period of time and patients were interviewed at their routine follow-up visit. Patients were asked to quantify the pain level that they had been experiencing at their ICBG site over the previous month based on the 1-10 Visual Analogue Scale (VAS).

Results: 59 patients (49 AIS, 10 Scheuermann’s Kyphosis) had ICBG harvest either by open incision or by accessing the iliac crest via the posterior spine incision. Data was collected at the 1-year post-op visit for 26 patients, at the 2-year post-op visit for 22 patients and at the 3+-year visit for 11 patients. Of the 59 patients, 50 had harvest of ICBG through a separate oblique incision over the right posterior superior iliac crest and 9 patients had the ICBG harvest performed via the already existing posterior spine incision. 52 patients rated their pain level as 0 (88%), 2 patients rated their pain level as 1 (3%), 4 patients rated their pain level as 2 (7%), and one patient rated their pain level as 3 (2%). When evaluating pain based on the type of skin incision, 6 of the 50 patients (12%) with a separate oblique incision had pain compared to 1 of 9 patients (11%) that had the ICBG harvest performed via extension of the posterior spine incision.

Conclusion: Previous findings report post-operative ICBG pains in 10-26% of patients with the most common being chronic donor site pain, tenderness, and sensory disturbances. This series shows that ICBG pain is absent in the majority of patients (88%) and of limited severity in those patients that reported pain (VAS score <= 3). As multiple options for bone graft substitutes become available, the use of autograft bone is being scrutinized. This study shows that the post-operative morbidity associated with autograft use is minimal in adolescent patients.