Autologous Bone-Grafts: Problems at the Donor Site
Contrary to most other publications about autologous bone grafting, the discussion in this paper does not concern the biologic reaction and the ingrowth of the graft but the problems that arise at the donor site. Even if cancellous bone of all parts of the skeleton may act as grafts, the quantity and quality of the pelvic bone favor the iliac crest, either anteriorly or posteriorly. Corresponding to the need of the mechanical properties of the graft, the pelvis offers both the pure cancellous bone and the corticocancellous bone in a sufficient amount. However the price of taking bone from the iliac crest is paid by a fairly high complication rate: up to 21% of operations with autologous corticocancellous bone grafts caused more or less severe complications. Only 16 out of 50 nonselected patients who underwent autologous bone grafting from the pelvis for anterior spondylodesis were without any complaints concerning the donor site. In four patients, reintervention at the iliac crest were necessary.