jws1217
08-21-2003, 03:31 PM
Hi
I have been battling severe pain from my left rear lower hip area right near my SI joint. I thought I was safe hear in Upstate NY having access to some top Doctors. I first took pain medicine mostly Oxicontin up to 80mg(still had pain). Just last week I had stopped taking pain med and have to admit the pain is the same.
I am a walking c-6 c-7. So originally everyone thought SI joint due to the walking though when I laid on the bed and had my wife apply a medicated Gel I found it to be exactly where my bone graph had come from. I went to the Hospital due to the pain and had all regular test done Catscan, Xrays, Bone Scan and Spinal Tap. I then went for the result of the test to my surgeon and he had said the RIGHT side look fine. Did I mention it was my Left side is where my pain was? I contacted the facility and hope to here something regarding the Bone Scan.
Questions
1)My Dr said he has had many people over the last 20 years complain from pain at the donor site of the bone graph. If so what is the fix? I can not believe I am the 1st to push this issue.
2) Has anyone had any success with medications for treating a specific area
3) Who could I contact in the US regarding The SI area/Bone Graph. I have spent time at Albany Medical Center and Kessler in NJ. Any suggestion on who would aggressively look into this. (Anywhere)
Thanks to all for any information
Wise Young
08-22-2003, 02:44 AM
JWS, I tried to look for some studies. You might find these of interest. Wise.
• Cowan N, Young J, Murphy D and Bladen C (2002). Double-blind, randomized, controlled trial of local anesthetic use for iliac crest donor site pain. J Neurosci Nurs 34:205-10. Summary: Autogenous iliac crest bone grafts are often used for persons undergoing anterior cervical fusion (ACF). Study findings have shown that pain at the iliac crest donor site can often be more severe than that at the primary operation site. A method used to eliminate pain after bone harvesting involves infiltration of a local anesthetic directly into the site. This study examined the efficacy of local anesthetic infiltration in the control of donor site pain, utilizing a randomized, double-blind, placebo-conrolled design. All participants received standard postoperative intravenous and oral analgesic. Those in the study group also received six injections of bupivacaine hydrochloride 0.25% into the donor site, while participants in the placebo group received normal saline injections. Participants receiving bupivacaine (n = 14) consistently reported lower hip pain scores than participants receiving the placebo (n = 8), with significant differences noted 3 hours after the first and second doses of the study drug. The bupivacaine group's mean morphine intake for the first 24 hours after surgery was found to be lower (32 mg; placebo 44 mg), whereas participants younger than 49 years who received bupivacaine were found, on average, to have stayed in the hospital one day less (3.6 days) than placebo group participants (4.5 days). Younger participants receiving bupivacaine required less morphine and had, on average, a reduced length of stay. The clinical implication of using local anesthetic for the relief of donor site pain suggests that it is a safe and efficacious technique. Department of Nursing Research and Development, Q Block Sir Charles Gairdner Hospital, Hospital Ave, Nedlands, 6009 Australia.
• Gibson S, McLeod I, Wardlaw D and Urbaniak S (2002). Allograft versus autograft in instrumented posterolateral lumbar spinal fusion: a randomized control trial. Spine 27:1599-603. Summary: STUDY DESIGN: To evaluate the clinical outcome respective of the type of bone graft used, 69 patients undergoing instrumented lumbar spinal fusion were randomized to receive either their own bone (harvested from the iliac crest) or allograft bone (fresh-frozen femoral head from donors undergoing total hip joint arthroplasty). Self-completed questionnaires were administered before surgery and at intervals thereafter. OBJECTIVES: To compare the clinical outcome of lumbar spinal fusion carried out using either allograft or autograft bone. SUMMARY OF BACKGROUND DATA: Previous studies have suggested that allograft bone is effective in cervical and thoracic fusion operations but that it is less effective in lumbar spinal fusions. Most of these studies used a radiographic means of determining fusion. However, no reliable radiologic assessment method has yet been agreed upon. It has also been shown that radiographic appearance does not correlate with clinical outcome. METHODS: A total of 69 patients undergoing instrumented posterolateral lumbar spinal fusion surgery were randomized to receive either allograft bone from the North East of Scotland Blood Transfusion Service or autologous bone from the iliac crest. The patients were then followed up at 1-year intervals over 6 years regarding clinical outcome. RESULTS: Patients receiving allograft bone had outcome scores similar to those who had received their own bone, except that in the autograft group there was a significant incidence of donor site pain that was persistent in about one sixth of patients. CONCLUSIONS: Allograft bone, in the form of fresh-frozen human femoral head, gives clinical results at least as good as autograft bone in instrumented posterolateral lumbar spinal fusion and completely avoids any donor site complications. Department of Orthopaedic Surgery, Woodend Hospital, Aberdeen, Scotland.
• Ryu JS, Kim JS, Moon DH, Kim SM, Shin MJ, Chang JS, Park SK, Han DJ and Lee HK (2002). Bone SPECT is more sensitive than MRI in the detection of early osteonecrosis of the femoral head after renal transplantation. J Nucl Med 43:1006-11. Summary: We compared the diagnostic sensitivity of (99m)Tc-methylene diphosphonate bone SPECT and MRI in the early detection of femoral head osteonecrosis after renal transplantation. METHODS: The patients were 24 renal allograft recipients who underwent both bone SPECT and MRI within 1 mo of each other because of hip pain but normal findings on plain radiography. SPECT was considered positive for osteonecrosis when a cold defect was detected in the femoral head, and the defect was further classified according to the presence of adjacent increased uptake: type 1 = a cold defect with no adjacent increased uptake; type 2 = a cold defect with adjacent increased uptake. MRI was considered positive for osteonecrosis when a focal region with low signal intensity on T1 images was detected in the femoral head. Final diagnoses were made by surgical pathology or clinical and radiologic follow-up of >1 y. RESULTS: A total of 32 femoral heads, including 24 of 29 painful hips and 8 of 19 asymptomatic contralateral hips, were confirmed as having osteonecrosis. SPECT detected osteonecrosis in all 32 of the femoral heads, resulting in a sensitivity of 100% (32/32), whereas MRI detected osteonecrosis in 21 femoral heads, for a sensitivity of 66% (21/32, P < 0.005). SPECT showed the type 1 pattern in 13 and the type 2 in 19. Ten of the 13 femoral heads with the type 1 pattern were false-negative on MRI, whereas only 1 of 19 with the type 2 pattern was normal on MRI [P < 0.001). There were 6 femoral heads with normal MRI findings and abnormal SPECT findings [type 1 pattern) in 3 patients, for whom hip pain decreased and radiographic findings were normal during follow-up. Follow-up bone SPECT showed a decreasing area of cold defect in 4 femoral heads. CONCLUSION: [99m)Tc-methylene diphosphonate SPECT is more sensitive than MRI for the detection of femoral head osteonecrosis in renal transplant recipients. Bone scintigraphy with SPECT is needed to diagnose osteonecrosis in patients with hip pain despite normal radiography results after renal transplantation. The significance of a transient SPECT abnormality needs to be clarified by further natural history studies. Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. jsryu2@amc.seoul.kr
• Wang MY, Levi AD, Shah S and Green BA (2002). Polylactic acid mesh reconstruction of the anterior iliac crest after bone harvesting reduces early postoperative pain after anterior cervical fusion surgery. Neurosurgery 51:413-6; discussion 416. Summary: OBJECTIVE: Autologous iliac crest bone enhances the rate of spinal arthrodesis. However, graft site complications are common, with donor site pain being particularly troublesome. Reconstruction of the hip defect with an absorbable polylactic acid mesh to restore the bony cortical contour has been proposed to reduce hip pain. METHODS: Thirty-nine consecutive patients treated by a single senior surgeon (BAG) during a 14-month period were studied. All patients had cervical spondylosis treated through an anterior approach supplemented with an autologous hip graft. Patients with preexisting hip pain were excluded. Pain was rated on a scale of 1 to 10 at 1 week and 3 months after surgery via a questionnaire. Postoperative pain medication regimens were standardized. RESULTS: Thirty patients were available for follow-up, 15 with mesh implantation and 15 without. Hip pain in the mesh-treated group averaged 4.7 and 1.6 at 1 week and 3 months, respectively. Hip pain in the standard-treatment group averaged 6.9 and 2.5 at 1 week and 3 months, respectively. These differences were statistically significant (P = 0.004 at 1 wk and 0.055 at 3 mo). Hospital length of stay was shorter in the mesh-treated group (2.1 versus 3.2 d, respectively), but this difference was not statistically significant. Two patients without mesh treatment complained of the cosmetic defect resulting from absent bone, and three had temporary difficulty with hip eversion or flexion. Two patients in the mesh-treated group developed seromas, which were treated conservatively. CONCLUSION: Reconstruction of the iliac crest reduces early postoperative pain. Other potential benefits may include shorter hospitalizations and a reduced incidence of hip weakness; however, careful attention to wound closure is necessary to prevent seroma formation. Department of Neurological Surgery, University of Miami School of Medicine, Florida 33136, USA. myw@hsc.usc.edu
• Chan K, Resnick D, Pathria M and Jacobson J (2001). Pelvic instability after bone graft harvesting from posterior iliac crest: report of nine patients. Skeletal Radiol 30:278-81. Summary: OBJECTIVE: To report the imaging findings in nine patients who developed pelvic instability after bone graft harvest from the posterior aspect of the iliac crest. DESIGN AND PATIENTS: A retrospective study was performed of the imaging studies of nine patients who developed pelvic pain after autologous bone graft was harvested from the posterior aspect of the ilium for spinal arthrodesis. Plain films, bone scans, and CT and MR examinations of the pelvis were reviewed. Pertinent aspects of the clinical history of these patients were noted, including age, gender and clinical symptoms. RESULTS: The age of the patients ranged from 52 to 77 years (average 69 years) and all were women. The bone graft had been derived from the posterior aspect of the iliac crest about the sacroiliac joint. All patients subsequently developed subluxation of the pubic symphysis. Eight patients had additional insufficiency fractures of the iliac crest adjacent to the bone graft donor site, and five patients also revealed subluxation of the sacroiliac joint. Two had insufficiency fractures of the sacrum and one had an additional fracture of the pubic ramus. CONCLUSIONS: Pelvic instability is a potential complication of bone graft harvesting from the posterior aspect of the iliac crest. The pelvic instability is manifested by insufficiency fractures of the ilium and subluxation of the sacroiliac joints and pubic symphysis. Department of Radiology, School of Medicine, University of California, San Diego Medical Center, 92103-1990, USA.