General Session: Innovative Technologies II - Hall F

Presented by: B. Haws

Author(s):

B. Haws(1), B. Khechen(1), K. Cardinal(1), J. Guntin(1), K. Singh(1)

(1) Rush University Medical Center, Orthopaedic Surgery, Chicago, IL, United States

Abstract

Introduction: Iliac crest bone grafting (ICBG) is an effective graft option for lumbar fusion procedures. Previous studies have reported an association between ICBG and increased postoperative pain and morbidity. However, the relationship between bone graft technique and postoperative outcomes for minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) has not been well defined.

Purpose: To determine the effect of ICBG on patient reported outcomes and complication rates following MIS TLIF.

Methods: Primary, single-level MIS TLIF patients were consecutively analyzed. A prospective cohort of patients that received a percutaneous technique of ICBG was compared to a retrospective cohort of patients that received Bone Morphogenic Protein-2 (BMP-2). A tubular dilator was utilized to harvest cancellous iliac crest graft (40cc). Baseline demographics and operative characteristics were compared between groups. Complication rates were assessed for the perioperative period and up to 6-months postoperatively. Postoperative changes in Oswestry Disability Index (ODI), Visual Analog Scale (VAS) back and VAS leg pain from preoperative values were compared between cohorts. Rates of minimum clinically important difference (MCID) achievement at 6-month follow-up for ODI, VAS back, and VAS leg scores was compared between groups. Statistical significance was set at p< 0.05.

Results: A total of 92 patients were included in this analysis, 46 in each cohort. No significant differences in preoperative characteristics existed between cohorts. Significant increases in operative time (13.33 minutes, p=0.016) and estimated intraoperative blood loss (15.54 mL, p=0.030) were demonstrated for the ICBG cohort. A greater percentage of ICBG patients were discharged on postoperative day 0 (19.6% vs 14.4%, p=0.072) though this did not reach statistical significance. No significant differences in complication rates were identified. The ICBG cohort demonstrated greater improvements in VAS leg pain at 12-week follow-up (-4.6 vs -3.2, p=0.032) compared to the BMP-2 cohort. No other significant differences in patient reported outcomes or rates of MCID achievement were identified between groups.

Conclusions: Patients undergoing MIS TLIF with ICBG experienced clinically insignificant increases in operative time and estimated blood loss. Use of ICBG did not lead to increases in pain, complications, pseudarthrosis rates, or delays in discharge. These results suggest that the use of ICBG is a safe and effective option for patients undergoing MIS TLIF.

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