Outcomes following posterior fusion for adolescent idiopathic scoliosis with and without autogenous iliac crest bone graft harvesting

Study Design: Retrospective. Summary of Background Data: There is continued controversy regarding the morbidity associated with harvesting iliac crest bone graft (ICBG). More important, its effect on clinical outcomes is poorly understood. Objectives: The purpose of this study was to determine whether harvesting ICBG affects clinical outcomes after posterior instrumented fusion in patients with adolescent idiopathic scoliosis (AIS). Methods: We identified patients enrolled in a prospective, multicenter database of patients with AIS who had posterior instrumented fusion with complete preoperative and 2-year postoperative Scoliosis Research Society (SRS)-22R data. Patients who had a previous fusion, thoracoplasty, or anterior surgery were excluded. We classified patients into 2 groups: those who underwent ICBG harvest (ICBG group) and those who did not (non-ICBG group). Results: We included 342 patients in the ICBG group versus 563 in the non-ICBG group. There were no significant differences in preoperative age (14.9 vs. 14.8; p = .178), major Cobb angle (51.3 vs. 51.8; p = .782), minor Cobb angle (34.8 vs. 35.1; p = .846), or Pain (4.11 vs. 4.11; p = .912), Appearance (3.29 vs. 3.33; p = .384), Activity (4.15 vs. 4.14; p = .847); Mental (3.95 vs. 4.00; p = .313), or Total (3.86 vs. 3.87; p = .603) SRS-22R scores. The average operative time was slightly longer in the ICBG group (293.55 vs. 276.21 minutes; p = .002). Estimated blood loss was greater in the ICBG group (939.47 vs. 723.63 mL; p = .000; 12.2% vs. 9.2% estimated blood volume; p = .000). The average number of levels fused was similar between groups (10.6 vs. 10.3; p = .137). There were no significant differences in any of the postoperative SRS-22R domains: Pain (4.30 vs. 4.34; p = .373), Appearance (4.23 vs. 4.19; p = .310), Activity (4.31 vs. 4.33; p = .509), Mental (4.20 vs. 4.23; p = .532), Satisfaction (4.42 vs. 4.43; p = .870), or Total Score (4.27 vs. 4.29; p = .674). By 2-year follow-up, there was 1 nonunion reported in the ICBG group and none in the non-ICBG group. Conclusions: After posterior instrumented fusion surgery for AIS, ICBG harvesting was associated with longer operative times and increased blood loss, but did not influence 2-year outcomes, which included pain and appearance scores.