Iliac Crest Bone Graft for Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Prospective Analysis of Inpatient Pain, Narcotics Consumption, and Costs

Document Type

Article

Publication Date

8-2018

Abstract

BACKGROUND CONTEXT Iliac crest bone grafting (ICBG) has been associated with enhanced fusion rates. However, concerns have been raised in regard to increased operative time and postoperative pain. The advantages of ICBG compared to other spinal fusion adjuncts have been debated. However, little is known regarding this technique in the setting of a minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). STUDY DESIGN/SETTING Prospective cohort. PATIENT SAMPLE Ninety-eight patients who underwent a MIS TLIF procedure with ICBG or BMP-2, 49 in each cohort. OUTCOME MEASURES Inpatient narcotics consumption in oral morphine equivalents (OME), Visual Analog Scale (VAS) pain, and direct hospital costs. METHODS Prospective, consecutive analysis of patients undergoing primary, single-level MIS TLIF with ICBG were compared to a historical cohort of consecutive patients that received BMP-2. Operative characteristics were compared between groups using chi square analysis or independent t test for categorical and continuous variables, respectively. Postoperative inpatient pain was measured using the VAS, and inpatient narcotics consumption was quantified as OMEs for both groups. Outcomes were compared between groups using multivariate regression controlling for preoperative characteristics. Statistical significance was set at p<.05. RESULTS A total of 98 patients were included in this analysis, 49 in each cohort. No significant differences were noted between cohorts except in regard to gender (more males in the BMP cohort, 67.35% vs. 46.94%, p=.041). There was a significant increase in operative time (14.53 minutes, p=.006) and estimated blood loss (16.64 mL, p=.014) in the ICBG cohort. No significant differences were identified for inpatient length of stay or VAS scores. Narcotics consumption was similar between groups on postoperative days 0 and 1. ICBG was associated with decreased total direct costs ($19,315 vs. $21,645, p<.001) as compared to BMP-2. CONCLUSIONS Patients undergoing MIS TLIF who underwent ICBG experienced increases in operative time and estimated blood loss that were not clinically significant. Furthermore, iliac crest harvesting did not result in either an increase in acute pain or narcotics consumption. Further follow-up is necessary to determine the associated arthrodesis rates and long term outcomes between each cohort. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

DOI

10.1016/j.spinee.2018.06.079

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