Neurospine.  2019 Dec;16(4):772-779. 10.14245/ns.1938006.003.

Impact of Iliac Crest Bone Grafting on Postoperative Outcomes and Complication Rates Following Minimally Invasive Transforaminal Lumbar Interbody Fusion

• Haws BE
• Khechen B
• Patel DV
• Yoo JS
• Guntin JA
• Cardinal K
• Ahn J
• Singh K

• KMID: 2469056
• DOI: http://doi.org/10.14245/ns.1938006.003

Abstract

OBJECTIVE
The relationship between bone graft technique and postoperative outcomes for minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) has not been well-defined. This study aims to determine the effect of iliac crest bone grafting (ICBG) on patient-reported outcomes (PROs) and complication rates following MIS TLIF.
METHODS
Primary, single-level MIS TLIF patients were consecutively analyzed. Patients that prospectively received a percutaneous technique of ICBG were compared to patients that retrospectively received bone morphogenetic protein-2 (BMP-2). Complication rates were assessed perioperatively and up to 1 year postoperatively. Changes in Oswestry Disability Index (ODI), visual analogue scale (VAS) back, and VAS leg pain were compared. Rates of minimum clinically important difference (MCID) achievement at final follow-up for ODI, VAS back, and VAS leg scores were compared.
RESULTS
One hundred forty-nine patients were included: 101 in the BMP-2 cohort and 48 in the ICBG cohort. The ICBG cohort demonstrated increases in intraoperative blood loss and shorter lengths of stay. ICBG patients also experienced longer operative times, though this did not reach statistical significance. No significant differences in complication or reoperation rates were identified. The ICBG cohort demonstrated greater improvements in VAS leg pain at 6-week and 12-week follow-up. No other significant differences in PROs or MCID achievement rates were identified.
CONCLUSION
Patients undergoing MIS TLIF with ICBG experienced clinically insignificant increases in intraoperative blood loss and did not experience increases in postoperative pain or disability. Complication and reoperation rates were similar between groups. These results suggest that ICBG is a safe option for MIS TLIF.

Keyword

Minimally invasive transforaminal lumbar interbody fusion; Iliac crest bone graft; Bone morphogenic protein-2; Oswestry Disability Index; Visual analogue scale; Minimum clinically important difference

MeSH Terms

Bone Transplantation*
Cohort Studies
Follow-Up Studies
Humans
Leg
Operative Time
Pain, Postoperative
Prospective Studies
Reoperation
Retrospective Studies
Transplants