In part 5 of our series, we'll take a closer look at a surprising source of pain that this young mother experienced after having a 360 fusion at L4-S1 with bone graft.

Read Tips for a Young Mother's First Day Home after Spine Surgery: Part 4

This image shows the largest bone in the pelvis, the ilium. The rounded upper ridge of the bone is called the iliac crest, and it is often used for bone grafts because of its accessibility and quantity of bone material.

Before her surgery, Sarah's surgeon downplayed the pain she would experience from her bone graft site. He claimed that because she was slender, very little tissue would have to be cleared away from the iliac crest, making the procedure less invasive.

Read more: Autograft: The Patient's Own Bone

However, after the immediate pain in her back was under control (about two weeks post-op), she began to feel a very dull, radiating pain originating right underneath the iliac crest incision. She noticed the graft site was tender to the touch and that any pressure on it was painful, including the pressure from her back brace.

See Bone Graft Site Pain and Morbidity After Spinal Fusion

Her skin was hot, and the area around the incision was swollen and "angry." The pain persisted well past her 6 week post-op appointment. At her appointment, she asked her surgeon, "How much longer can I expect this pain to continue?" His answer was, "another 6 weeks."

Sarah had to continue to take her pain medication to help her deal with the pain.


She is 9 weeks post-op now and still does have a bit of pain at the site, although it has slowly lessened.

Sarah believes that because the entire operation is so huge, the main focus of concern is the fusion itself. In comparison, the bone graft is a relatively small part of the surgery, so there is not much discussion about what a patient can expect with the graft.

She was not offered a choice of a donor bone or an artificial material. Her surgeon told her he prefers not to use artificial bone growth stimulators because they can cause too much bone growth.

See Allograft: Cadaver Bone from a Tissue Bank and How an Electrical Bone Growth Stimulator Helps with Spine Fusion

Sarah commented, "The pain associated with the graft surprised me. I called the surgeon's nurse to ask whether my symptoms were normal, as he had made the bone graft seem insignificant. And it was, in the beginning at least, when my back, muscle, and incision pain were my main focuses. In retrospect, I wish more information was made available to me in my discharge papers concerning the graft. Hot baths did lessen the ache and I continued using my lidocaine patches when necessary."

Sarah discussed her bone graft pain in our forums, and many members chimed in to agree with her that their bone graft pain was much more significant than they had expected.

Were you surprised by the intensity of your bone graft pain? Share your experiences on our forums, or on our Facebook and Twitter pages.