The patient-reported outcome of chronic pain after the harvest of anterior iliac bone for anterior cervical arthrodesis

Abstract

Background: Anterior cervical fusion (ACF) with autologous iliac bone graft is a traditional surgical method, but high rate of chronic pain (30%) at the anterior iliac crest presents a considerable hindrance to harvesting iliac bone. The memory of acute pain may become fainter as time progresses, and the incidence of chronic pain may not be as high as previously reported. The primary objective was to show the patient-reported outcome of chronic pain in the anterior iliac crest. Methods: Telephone surveys were conducted for patients with single-level ACF (group-S; n = 72; M: F = 52:20; median age, 53 years), multiple-level ACF (group-M; n = 61; M:F = 40:21; 56 years) using autologous iliac bone, and single-level ACF with a stand-alone cage (group-C; n = 53; M:F = 38:15; 51 years). Logistic regression analysis was performed to determine the risk factors, and the variables included group, age, gender, postoperative period and satisfaction with the surgical outcome. Results: There was no chronic pain in 87% of the patients, with no difference among the groups (p = 0.52). During the acute postoperative period, patients remembered no pain in 38/72 (53%) patients of group-S, 25/61 (41%) of group-M and 42/53 (79%) of group-C (p < 0.001). Female gender (p = 0.027; OR, 2.68; 95% CI, 1.12-6.41) was the risk factor for chronic pain. Conclusions: Iliac bone harvest may not cause chronic pain in 87% of patients, and the memory of acute pain was faded in 40-50% of patients. Female gender was a risk factor for chronic pain. This information should be considered before harvesting iliac bone. (C) 2016 Elsevier Ltd. All rights reserved.