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Patient Perceptions of Iliac Crest Bone Grafting in Minimally Invasive Transforaminal Lumbar Interbody Fusion

Haws, Brittany E. MD; Khechen, Benjamin BA; Patel, Dil V. BS; Cardinal, Kaitlyn L. BS; Guntin, Jordan A. BS; Singh, Kern MD

doi: 10.1097/BSD.0000000000000781
Primary Research

Study Design: Retrospective cohort.

Objective: The objective of this study was to determine patients’ perception of iliac crest bone graft (ICBG) harvesting and donor site pain following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).

Summary of Background Data: The incidence of donor site pain has been debated in the literature because of the varying techniques associated with its harvest.

Methods: Patients undergoing primary, single-level MIS TLIF with ICBG were retrospectively identified. ICBG harvesting was performed using a percutaneous technique with a tubular retractor. A survey was administered to assess if patients could accurately describe which side of their iliac crest they believed was harvested, and if they were experiencing any pain perceived to be originating from the donor site. Patient characteristics were compared using χ2 analysis and independent t test.

Results: In total, 82 patients were included. The majority of patients had the ICBG harvested from the left iliac crest (97.5%). Approximately half of the patients correctly identified the side of harvest (50.6%). 48.1% of patients reported they were not confident or had guessed on their response. Patients that reported pain from the ICBG were more likely to feel confident or somewhat confident in their harvest site identification (57.9% vs. 46.3%) but less likely to be correct (36.8% vs. 63.4%) than patients without pain. 22 patients (27.8%) correctly identified the side of harvest without guessing. Of these, 11 (13.9%) reported pain.

Conclusions: Approximately half of patients undergoing MIS TLIF with ICBG are able to correctly identify which side of their iliac crest was harvested. However, the majority of patients reporting pain were unable to correctly identify the side of harvest. This suggests that most patients are likely attributing other sources of pain to their ICBG. Therefore, rates of donor site pain may be over-reported in the current literature with contemporary harvesting techniques.

Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL

The authors declare no conflict of interest.

Reprints: Kern Singh, MD, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Suite #300, Chicago, IL 60612 (e-mail:

Received July 16, 2018

Accepted January 3, 2019

© 2019 by Lippincott Williams & Wilkins, Inc.