Iliac crest bone graft: a 23-years hystory of infection at donor site in vertebral arthrodesis and a review of current bone substitutes

OBJECTIVE: This is an exemplary case report underlining a relevant morbidity which could be associated to the use of autologous iliac crest bone graft (ICBG) for spine fusion. CASE REPORT: Starting from 1990, a 25-years-old woman underwent two subsequent surgical treatments for non-Hodgkin lymphoma vertebral localizations. In the second surgery, arthrodesis was obtained with autograft through right posterior iliac crest osteotomy. During the chemotherapy treatment following the surgery, the patient suffered from infection at posterior iliac crest scar, the site of previous graft, caused by methicillin-resistant Staphylococcus aureus. She was subjected to surgical debridement and specific antibiotic treatment with local healing and phlogosis index reduction. Chemotherapy protocol was concluded and the patient healed with definitive lymphoma remission. After 22 years the patient had a relapse of donor site infection, requiring a new antibiotic therapy and a new surgical debridement. RESULTS: The relapsed infection at donor site lasted for a long period, more than one year, despite of specific care. It finally healed after another accurate surgical debridement and postoperative antibiotic therapy. CONCLUSIONS: This case report underlines the possible consequences on the patient's quality of life of a long-term disease affecting the iliac crest bone graft donor site. Literature concerning alternatives to autograft for spine fusion is also reviewed.