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  1. #1

    Pain from bone donor site for surgery

    Hi all

    I forgot to ask in my last post I have had pain from where the doctors took the bone from in my back left rear illiac crest area. I have described it to my sureon for years as being bone pain exactly from wher ehe chipped the bone from. He said he has not heard anyone complaining that they had pain from that area after surgery. I find this hard to believe.
    I had a resident tell me not to long ago that they no longer take bone from the illiac crest area because it was to painful. Who do I believe? What makes me mad is that for years the surgeon has made me feel like an idiot and that it was in my head. I had so many different procedures to get rid of that pain I feel like a pin cusion. Just wondering who to believe the surgeon or his new resident that I think told me the truth.
    Has anyone had pain from there bone donor site????

    Thanks
    Mark

  2. #2
    Oh yes. I had bone taken from two sites on my pelvis for my anterior and posterior fusions (C2-T4), and have pain at these sites even now, 22 years after the done was harvested. Several people I talked with before I had the fusions done told me that the pain they had where the bone was taken was far worse than any of the surgical pain they experienced from the fusions themselves.

    Don't let anyone make you believe you're crazy for having pain. You know your body better than anyone.

    --THC

  3. #3
    Mark - I will give you the answer to your question.

    Believe the resident in this case. The donor sites are notorious for being painful for months after surgery. I am 10 months out and still have tenderness over my right iliac crest.

    The other question is why your surgeon says he never heard of anyone with this. Maybe he heard but doesn't really listen !

  4. #4
    jws

    The idea of fusion is to view the spine in terms of motion segments. If a particular segment, say C5, can be fixed, or fused to the vertebrae below, then concerns about narrowing of the spinal canal and pressure on the cord or spinal arteries at that level are reduced, because the flexion and extension at that motion segment pretty much ceases. Some doctors feel that spasm of the spinal arteries is a much more common cause of cord injury than is commonly appreciated. Blood vessels in the CNS are much more prone to go into spasm than elsewhere in the body.

    When doing a medial branch block for cervical facet syndrome, the concern is that if the needle passes the epidural space, the local anesthetic might cause spasm of the spinal artery or even the vertebral artery.

    If the veins are compressed then blood cannot exit the cord. This is the mechanism of injury where the MRI appears not to show indentation of the cord, but the space where the vessels run in front of the cord is compromised. Hence, despite the MRI, if flexion or extension gives you symptoms, the clinical picture is very important. My surgeon used to swear he could tell who was having cord compression on flexion/extension just by asking the right questions. Most do not agree, but this was a very good spine surgeon. On the other hand, neuroradiologists have a tendency to say no significant cord compression, when in fact there is slight effacement (touching) and the space for the vessels is too small.

    Alternatively, the MRI is done with the head upright. When dynamic studies are done, with flexion and extension the canal can narrow by 2-3 mm. This can turn a slight effacement into outright cord compression. Prolonged positioning like that, such as when sleeping, or with a blow (car accident) spasm of the vessels can cause harm. That is why notification and cautions are in order for anyone with canal narrowing. The cord is typically 9mm anterior to posterior. If the canal is that narrow with the head upright, the patient should be cautioned to avoid flexion/extension. Again, think of the changes at each motion segment.

    The data on force/time to cause cord injury do not always include considerations of vessels and almost none have differentiated trauma at left C4 with other levels. The upper cord can borrow some blood from the loop of Henle and the lower cervical cord can borrow from the spinal arteries, but if C4is the primary supply for the mid cervical cord, it is vital.

    Neuroradiologists are very valuable, but it is desirable for a clinician to make the final call and radiologists should not presume to know what is significant and what is not. The blood supply of the mid cervical levels of cord comes in from radicular arteries at about C4, usually on the LEFT side. If that area is tight, the usual method of considering only the spinal arteries in front of the cord is not a reliable indicator of what is going on. That is why you need a clinician.

    It drives me crazy when neuroradiologists who have a numerical cursor ready right on the MRI screen, nevertheless dumb it down and use words like "slight" narrowing, "marked" narrowing, when we really ought to be getting numbers for both the canal and the cord, such as 10mm or 6mm. This would help the doctor have a more accurate picture. The ratio of cord size front to back and side to side is also important. If the AP is less than 40 percent of the side to side, then you can call cord compression, even if it is not clear. The determination of what is significant is for the clinician, not the radiologist. For example, I have a cervical cord which is 12 mm, very large, probably requiring a 13 mm canal. If the canal is only 12 mm there is a problem, although in most people 12 mm of canal space is plenty of room. So numbers are always more helpful than "small, slight, significant, moderate" or whatever. It takes less than one minute to run the measuring cursors over cord and canal on a GE machine, but few radiologists/MRI techs take the time, which is unfortunate.

    The bad part of fusion, as Dr. Young has pointed out here, is that there is then increased loading on the disc space above and below the fusion, so you can set up a succession of problems. Think of it as grafting a straight fixed piece into the middle of a fishing rod. Where the straight piece, which does not bend, is attached above and below there is increased loading on the discs above and below the fusion.

    Pain from donor site is very common. I would say mine at 20 plus years out is about the same as it was at 1 year out. I am as surprised as Jon that you were told they never heard of it. The resident may be correct about that institution, or even most institutions, but many use the hip bone graft. Some use cadaver bone, and others use artificial substances. I don't think new methods have any better success rate of fusion than the old hip bone graft method. I have had both cadaver bone and my own hip.

    Cadaver bone has the disadvantage that you are exposed to foreign antigens and should you ever need a transplant there is a possibility you might retain some immunologic reaction to foreign donors. In either event the bone is replaced in about two years by your own body. No postop pain, no hip pain, no nothing pain matches my central pain. Central Pain is in a class all by itself for me. I would be interested to hear how anyone who got the new artificial disc material instead of bone is doing. Miami and about 20 other centers are using it.
    Last edited by dejerine; 01-30-2009 at 11:58 PM.

  5. #5
    I'm not very good with anatomy, so I'm not sure where the iliac crest is

    I had two cervical fusion operations in August 2007 - one anterior, and one posterior . The donor sites (front and back of my pelvis) hurt like hell for a while. When I was able to hike & backpack again, certain hipbelts would aggravate the sites. At one year post I was able to start rock climbing again and bought a new harness because my old one hurt the donor sites.

    But now it's 17 months post and that's pretty much gone away (glad I kept my old harness the new one had other annoying features). Someone (not a medical professional, just someone who had lots of operations) told me that the places where they took bone out eventually grow back, but I don't know if that's true or not - sounds like it doesn't work so well for some people. Anybody know the scoop ?

    edit: feels like there is still a notch in front, maybe it takes while ?

  6. #6
    Junior Member allen54's Avatar
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    Pain from bone donor site for sugery

    I had part of pelvic bone removed for neck fusion c5-6 and had problems with pelic area opening and bleeding. I had pain for 2 years.I also lost 35%
    of my strength on my left side (Cervical damage).

  7. #7
    Senior Member
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    jws -I agree w/thehipcrip, don't let anyone tell you that your pain is crazy or not real.

    I am more than 11 years post surgery, and I still have more tenderness at my donor site than anywhere else (and I've had lots of other surgeries). The sensation is very funny there, but it's close to my injury level, so I'm sure that plays some part in it.

    I hope you're feeling better!

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