Cervical Spine by Pier Paolo Maria Menchetti

Author:Pier Paolo Maria Menchetti
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Fig. 9.6Bone graft harvesting from the iliac crest according to the Cloward technique. (a, b) A hand-held drill provides a cylindrical, bicortical dowel graft that is impacted into the drilled defect

Donor Site Complications

The complication rate after harvesting bi- or tricortical iliac bone ranges from 4 to 39 % [2, 7]. Donor site complications include acute and chronic local pain, nerve injury, infection, hemorrhage, hernia formation and exceptional iliac crest fracture. The most commonly reported complication is acute postoperative pain at the donor site with resultant longer hospital stay. Several evidences suggest that donor site pain is the result of micro- and macro-fractures, hemorrhage and infection that trigger intact nociceptors adjacent to a nerve injury site [2, 9, 10, 14, 20, 23, 31]. A careful standard technique minimizes postoperative pain in most patients [29]. A short skin incision, limited muscle retraction, subperiosteal dissection, and reduced use of electrocautery prevent the injury to the lateral femoral cutaneous nerve, ilioinguinal nerve and lateral cutaneous branch of the subcostal nerve. Performing the most anterior osteotomy at least 2 cm behind the ASIS avoids a stress fracture of the bone remaining anterior to the harvest site. In addition, some evidences suggest that graft harvesting using single-bladed oscillating saw reduces the risk of stress fracture of the ASIS when compared with the osteotome technique [23, 29]. Finally, careful hemostasis, moderate use of electrocautery and avoidance of muscle stripping help to avoid pain, fluid collection, and cosmetic dissatisfaction [10].

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