ANALYSIS OF HARVEST MORBIDITY AND RADIOGRAPHIC OUTCOME USING AUTOGRAFT FOR ANTERIOR CERVICAL FUSION

Study Design. Retrospective study of 184 autologous iliac crest bone g rafts used for anterior cervical fusion in 144 procedures. Objectives. To evaluate the effect of autologous iliac crest bone graft harvest s ite on operation and recovery and to identify patients at risk for har vest morbidity. Summary of Background Data. Although autologous iliac crest bone graft is considered the most successful grafting material, concerns about harvest morbidity provide a rationale for considering a llograft. Data about the use of autograft therefore would assist spina l surgeons in selecting the appropriate substrates for fusion after an terior cervical decompression. Methods. Statistical analysis based on patient gender, smoking history, obesity, and medical or pharmacologic risk factors for wound healing was used to evaluate morbidity after p atient interviews and examinations. Limited assessment of radiographic outcome also was performed. Results. A second operation because of do nor site morbidity was performed in four patients (2.8%), but only one (0.7%) with meralgia paresthetica had permanent sequelae. Superficial wound infection or dehiscence occurred in 5.6% of patients, with a di sproportionate number of women, obese patients, and those with medical risk represented. Protracted wound symptoms of pain and poor cosmesis were reported in 2.8% and 3.5% of patients, respectively, and also we re found in a significant number of female and obese patients. Evidenc e of fusion was present in 97% of cases. Conclusion. Autologous iliac crest bone graft harvest results in minimal major morbidity when regio nal anatomy is respected and careful technique is observed. The identi fication of patients at risk for minor complications suggests that all ograft may be appropriate in these patients; however, prospective comp arison is required to identify whether graft material or technical fac tors determine fusion success and relative benefit.