자가 장골을 이용한 흉요추부 추체간 전방 유합술시 이식 장골 공여부 재건술 후 추시 결과

Abstract

Study Design A comparative retrospective study between those who have and have not undergone donor site reconstruction after thoracolumbar spinal anterior interbody fusion using an auto-iliac bone graft.

Objectives To determine the efficacy of iliac reconstruction in reducing iliac donor site morbidity.

Summary of Literature Review An autogenous bone graft harvested from the iliac crest is still the gold standard for spinal anterior interbody fusion. However, defects of a significant size often remain in the donor site, which may cause pain, pelvic instability and cosmetic deformity etc. Iliac donor site reconstruction with bone cement is one of the methods for reducing the donor site morbidity, with a relatively easy technique.

Materials and Methods A review of patients who underwent iliac bone graft harvesting, with or without reconstruction, by a single orthopaedic surgeon was conducted. The iliac donor site morbidity, at least one after remote surgery was compared in those who had and had not undergone iliac reconstruction. All patients were evaluated by an independent observer. During a two and half year period, 61 patients met the inclusion criteria. Twenty-three patients underwent iliac donor site reconstruction with bone cement and 9 with auto rib bone reconstruction, while the remaining 29 had no donor site reconstruction. Patients were asked to assess the duration and severity of their donor site pain, using a visual analogue scale (VAS), and other morbidity, such as cosmetic deformity.

Results The severity of chronic donor site pain was significantly reduced in the donor site reconstruction group; however, there were no statistically significant differences, other than chronic pain, in the morbidities.

Conclusions Iliac donor site reconstruction, with bone cement or auto-rib bone, is a relatively easy technique to perform after anterior spinal fusion. Better results can be expected, especially in reducing postoperative donor site pain.