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Ge CY, Dong L, Xu ZW, Yang WL, Qian LX, Yang XW, Hao DJ. Avulsion fracture of the anterior superior iliac crest following autograft for anterior lumbar fusion: case report and literature review. Front Surg 2024; 11:1327028. [PMID: 38327545 PMCID: PMC10847530 DOI: 10.3389/fsurg.2024.1327028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/12/2024] [Indexed: 02/09/2024] Open
Abstract
Avulsion fracture of the anterior superior iliac crest (ASIC) following autogenous bone grafting for anterior lumbar fusion (ALF) is an extremely rare complication. We describe a very rare case of avulsion fracture of the ASIC following autograft for ALF in a revision surgery for treating lumbar tuberculosis. A 68-year-old woman with lumbar tuberculosis underwent posterior debridement and posterior iliac crest bone graft fusion; however, her lumbar tuberculosis recurred 9 months after surgery. She then underwent a lumbar revision surgery, including removal of the posterior instrumentation and debridement, followed by anterior L2 corpectomy, debridement, anterior left iliac crest bone graft fusion, and internal fixation. When walking for the first time on postoperative day 3, she experienced a sharp, sudden-onset pain in the anterior iliac crest harvest area. X-ray revealed an avulsion fracture of the ASIC. Considering her failure to respond to conservative treatment for one week and large displacement of the fracture ends, an open reduction and internal fixation surgery was scheduled. Her pain symptoms were significantly relieved after the operation. Although rare, fracture of the ASIC following autograft for ALF should not be ignored. Fracture of the ASIC is usually treated conservatively. Additional surgical treatment is required only when intractable pain fails to respond to conservative treatment or when there is a large displacement of fracture ends that are not expected to heal spontaneously.
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Affiliation(s)
| | | | | | | | | | | | - Ding-Jun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Grechenig S, Worlicek M, Penzkofer R, Zeman F, Kujat R, Heiss P, Pattappa G, Zellner J, Angele P. Bone block augmentation from the iliac crest for treatment of deep osteochondral defects of the knee resembles biomechanical properties of the subchondral bone. Knee Surg Sports Traumatol Arthrosc 2019; 27:2488-2493. [PMID: 30370438 DOI: 10.1007/s00167-018-5242-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 10/17/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Bone block augmentation from the iliac crest can be used for reconstruction of the osteochondral unit to restore the underlying subchondral bone upon restoration of the cartilaginous layer via matrix-induced chondrocyte transplantation. To critically understand the successful restoration of the defect, biomechanical and histological analysis of the implanted bone blocks is required. The aim of the study was to analyse the ability of the bone block technique to restore huge bone defects by mimicking the physiological subchondral zone. METHODS The experiments were performed using lateral femoral condyles and iliac crest bone grafts from the same cadavers (n = 6) preserved using the Thiel method. CT scans were made to evaluate bone pathology. Bone mineral density of all specimens was evaluated in the femoral head prior to testing. A series of tests were conducted for each pair of specimens. A static compression test was performed using an electro dynamic testing machine with maximal strength and failure behavior analyzed. Biomechanical tests were performed in the medial-lateral direction for iliac crest and for femoral condyles with and without removal of the cartilage layer. Histological analysis was performed on decalcified specimens for comparison of the condyle at lesion site and the graft. RESULTS No significant difference in failure load could be found for iliac crest (53.3-180.5 N) and femoral condyle samples upon cartilage removal (38.5-175.1 N) (n.s.). The femoral condyles with an intact cartilage layer showed significantly higher loads (118.3-260.4N) compared to the other groups indicating that native or regenerated cartilage can further increase the failure load (p < 0.05). Bone mineral density significantly influenced failure load in all study groups (p < 0.05). Histological similarity of the cancellous bone in the femoral condyle and in the iliac crest was observed. However, within the subchondral zone, there was a higher density of sponge like organized trabeculae in the bone samples from the iliac crest. Tide mark was only detected at the osteochondral interface in femoral condyles. CONCLUSION This study demonstrated that, bone blocks derived from the iliac crest allow a biomechanical appropriate and stable restoration of huge bony defects by resembling the subchondral zone of the femoral condyle. Therefore, bone augmentation from the iliac crest combined with matrix-induced autologous chondrocyte transplantation seems to be a reasonable method to treat these challenging injuries.
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Affiliation(s)
- S Grechenig
- Clinic of Trauma Surgery, University of Regensburg, 93053, Regensburg, Germany
| | - Michael Worlicek
- Clinic of Trauma Surgery, University of Regensburg, 93053, Regensburg, Germany. .,Centre for Clinical Studies, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
| | - R Penzkofer
- Engineering and Technology, University of Applied Sciences Regensburg, 93053, Regensburg, Germany
| | - F Zeman
- Centre for Clinical Studies, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - R Kujat
- Clinic of Trauma Surgery, University of Regensburg, 93053, Regensburg, Germany
| | - P Heiss
- Clinic of Radiology, University of Regensburg, 93053, Regensburg, Germany
| | - G Pattappa
- Clinic of Trauma Surgery, University of Regensburg, 93053, Regensburg, Germany
| | - J Zellner
- Clinic of Trauma Surgery, University of Regensburg, 93053, Regensburg, Germany
| | - P Angele
- Clinic of Trauma Surgery, University of Regensburg, 93053, Regensburg, Germany
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Comprehensive analysis of the volume of bone for grafting that can be harvested from iliac crest donor sites. Br J Oral Maxillofac Surg 2017; 55:803-808. [PMID: 28843966 DOI: 10.1016/j.bjoms.2017.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 07/18/2017] [Indexed: 11/24/2022]
Abstract
Our aim was to calculate the volumes of cancellous, cortical, and corticocancellous bone that can be harvested as a graft from the anterior and posterior iliac crests using 3-dimensional computed tomography (CT) and software in a living adult population. We selected random CT scans of the pelvis from 31 men and 29 women from the Department of Radiology imaging database. CT data in DICOM file format were imported into Mimics software. The anterior iliac crest and posterior iliac crest bone graft-harvested boundaries were measured. The volume of the 3-dimensional cortical and cancellous bone grafts was measured using the Mimics software. There were significant differences in all comparisons between the anterior and posterior iliac crest, except for volumes of cortical bone. More cancellous and total corticocancellous bone can be harvested from the posterior than the anterior iliac crest, together with similar or smaller volumes of cortical bone. Sex, but not age, is an important factor in terms of the amount of bone that can be harvested, with a wide range of volumes individually from both iliac crests.
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Kirschner Wire and Bone Cement is a Viable Alternative to Reconstruction of Large Iliac Bone Defects After Strut Bone Graft Harvesting. Clin Spine Surg 2017; 30:308-313. [PMID: 28746126 DOI: 10.1097/bsd.0000000000000254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE To assess the safety and efficacy of iliac crest defect reconstruction using Kirschner wire (K-wire)/polymethylmethacrylate (PMMA) versus traditional autologous rib graft reconstruction. SUMMARY OF BACKGROUND DATA The iliac crest has been the preferred donor site for strut bone graft for various spinal fusion surgeries. METHODS Seventy-three patients (44 males and 29 females; average age: 57.2 y) were divided into 2 groups: the rib group (35 patients) and the K-wire/PMMA group (38 patients). All operations involved anterior spinal interbody fusion. Patients were followed-up, on average, for 34.2 months using plain radiographs and both pain and cosmesis visual analog scales (VAS) to assess the clinical results after surgery. RESULTS Almost all patients had pain VAS scores of ≤1 and grade 1 cosmesis VAS scores with no significant difference between the 2 groups in terms of either pain or cosmesis (P=1.00 and 0.505, respectively). In addition, few complications were noted in both groups. Radiographic complications in the rib group and the K-wire group numbered 4 (11%) and 2 (5%), respectively; however, did not significantly differ between the 2 groups (P=0.418). One case required intraoperative revision of the length of the K-wire and 1 case needed reoperation for iliac ring fracture and K-wire migration. An additional case required revision due to a bad fall. CONCLUSIONS K-wire and bone cement reconstruction is an effective and safe alternative method for large iliac bone defect repair when autologous rib graft is not available.
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Burk T, Del Valle J, Finn RA, Phillips C. Maximum Quantity of Bone Available for Harvest From the Anterior Iliac Crest, Posterior Iliac Crest, and Proximal Tibia Using a Standardized Surgical Approach: A Cadaveric Study. J Oral Maxillofac Surg 2016; 74:2532-2548. [PMID: 27524516 DOI: 10.1016/j.joms.2016.06.191] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 06/30/2016] [Accepted: 06/30/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE The 3 most common sites for obtaining autogenous bone grafts are the anterior iliac crest (AIC), posterior iliac crest (PIC), and proximal tibia (PT). The purpose of this study was to determine the maximum amount of corticocancellous bone that could be harvested from the AIC, PIC and PT when using a standardized surgical approach. MATERIALS AND METHODS The maximum volume of cortical and cancellous bone from the AIC, PIC, and PT was harvested from 44 cadavers using approaches from a review of the literature. Uncompressed and compressed corticocancellous bone volumes were measured by water volume displacement. Bivariate analyses of bone volumes, gender, and medical comorbidities were performed using the exact Wilcoxon rank-sum test. A general linear model using ranks was used to assess the effect of gender, medical comorbidity, and site separately for total uncompressed and compressed bone measurements. RESULTS Forty-two AIC corticocancellous grafts provided an uncompressed total average of 26.29 mL and a compressed total average of 20.58 mL. Thirty-three PIC grafts yielded a total average of 33.82 mL of uncompressed bone and 24.11 mL of compressed. Thirty-eight PT samples provided a total average of 18.11 mL of uncompressed bone and 9.03 mL of compressed bone. No statistically relevant correlations were found between compressed bone volumes and body mass index or age. No statistically relevant association was found between bone quantity and medical comorbidity for any of the graft sites. The average rank of bone volume per site after controlling for gender and medical comorbidity showed that the PIC yielded the most and the PT yielded the least compressed and uncompressed bone amounts (P < .001). CONCLUSION Results indicate that the PIC has a larger maximum amount of corticocancellous bone than the AIC and PT with a standardized approach. The maximum volumes of attainable bone from the AIC, PIC, and PT were lower than commonly cited in the literature.
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Affiliation(s)
- Thomas Burk
- Fourth-Year Resident, Department of Oral and Maxillofacial Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
| | - Jorge Del Valle
- Fourth-Year Resident, Department of Oral and Maxillofacial Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Richard A Finn
- Director, Section of Oral and Maxillofacial Surgery, Dallas Veteran's Affairs Medical Center, Dallas; Faculty, Department of Cell Biology and Neuroscience, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ceib Phillips
- Professor, Department of Orthodontics, University of North Carolina, Chapel Hill, NC
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de Lacerda PE, Pelegrine AA, Teixeira ML, Montalli VAM, Rodrigues H, Napimoga MH. Homologous transplantation with fresh frozen bone for dental implant placement can induce HLA sensitization: a preliminary study. Cell Tissue Bank 2016; 17:465-72. [DOI: 10.1007/s10561-016-9562-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 04/29/2016] [Indexed: 10/21/2022]
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Jain A, Hassanzadeh H, Strike SA, Menga EN, Sponseller PD, Kebaish KM. Pelvic Fixation in Adult and Pediatric Spine Surgery: Historical Perspective, Indications, and Techniques: AAOS Exhibit Selection. J Bone Joint Surg Am 2015; 97:1521-8. [PMID: 26378268 DOI: 10.2106/jbjs.o.00576] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Achieving solid osseous fusion across the lumbosacral junction has historically been, and continues to be, a challenge in spine surgery. Robust pelvic fixation plays an integral role in achieving this goal. The goals of this review are to describe the history of and indications for spinopelvic fixation, examine conventional spinopelvic fixation techniques, and review the newer S2-alar-iliac technique and its outcomes in adult and pediatric patients with spinal deformity. Since the introduction of Harrington rods in the 1960s, spinal instrumentation has evolved substantially. Indications for spinopelvic fixation as a means to achieve lumbosacral arthrodesis include a long arthrodesis (five or more vertebral levels) or use of three-column osteotomies in the lower thoracic or lumbar spine, surgical treatment of high-grade spondylolisthesis, and correction of lumbar deformity and pelvic obliquity. A variety of techniques have been described over the years, including Galveston iliac rods, Jackson intrasacral rods, the Kostuik transiliac bar, iliac screws, and S2-alar-iliac screws. Modern iliac screws and S2-alar-iliac screws are associated with relatively low rates of pseudarthrosis. S2-alar-iliac screws have the advantages of less implant prominence and inline placement with proximal spinal anchors. Collectively, these techniques provide powerful methods for obtaining control of the pelvis in facilitating lumbosacral arthrodesis.
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Affiliation(s)
- Amit Jain
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD 21287. E-mail address for K.M. Kebaish:
| | - Hamid Hassanzadeh
- Department of Orthopaedic Surgery, University of Virginia, PO Box 800159, Charlottesville, VA 22908
| | - Sophia A Strike
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD 21287. E-mail address for K.M. Kebaish:
| | - Emmanuel N Menga
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD 21287. E-mail address for K.M. Kebaish:
| | - Paul D Sponseller
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD 21287. E-mail address for K.M. Kebaish:
| | - Khaled M Kebaish
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD 21287. E-mail address for K.M. Kebaish:
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Long-term retrospective evaluation of the peri-implant bone level in onlay grafted patients with iliac bone from the anterior superior iliac crest. J Craniomaxillofac Surg 2015; 43:956-60. [DOI: 10.1016/j.jcms.2015.03.037] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 02/24/2015] [Accepted: 03/27/2015] [Indexed: 11/24/2022] Open
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Analysis of postoperative pain at the anterior iliac crest harvest site: a prospective study of the intraoperative local administration of ropivacaine. Asian Spine J 2015; 9:39-46. [PMID: 25705333 PMCID: PMC4330217 DOI: 10.4184/asj.2015.9.1.39] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 05/19/2014] [Accepted: 05/20/2014] [Indexed: 11/17/2022] Open
Abstract
Study Design This was a prospective randomized comparative study. Purpose The aim of this study was to objectify donor site-related pain following anterior iliac crest graft harvesting, in patients who have undergone multilevel anterior cervical discectomy and fusion with plating (ACDFP); and to assess the effect of an intraoperative local single injection of ropivacaine on postoperative pain. Overview of Literature Multilevel ACDFP can be associated with a high non-union rate. Autogenous iliac bone has been used to increase union rates, although a high incidence of donor site-related pain has been reported. Methods Forty consecutive patients who required 3-level or 4-level ACDFP were prospectively assessed for donor site-related pain. Pain levels were assessed daily for five days postoperative using the visual analog scale (VAS). Patients were randomly assigned to group A or B. In group A patients, 7-10 mL of ropivacaine (0.2%) was injected into the iliac crest after iliac crest graft harvesting. Morphine usage via patient controlled analgesia was calculated. At six months postoperative, patient complaints at the harvest site were documented. Results Patients were randomly assigned to group A or B. In group A, ropivacaine was locally administered at the site of the iliac crest graft harvest after fascia closure. In group B, no additional treatments were administered. The average patient age in group A was 56±7.6 years, whereas the average age of patients in group B was 52.6±10.4 years. Group A had an average of 0.6±0.7 previous surgeries per patient, whereas group B had an average of 0.8±1.0 previous surgeries per patient. The average number of levels fused in group A was 3.6±0.7, whereas the average number of levels fused in group B was 3.7±0.9 (all p>0.05). In group A, the mean ropivacaine volume administered was 8.4±1.5 mL. No patient complaints regarding chronic pain, were reported six months postoperatively. No complications were encountered from the harvest site, and all patients underwent successful 3-level and 4-level ACDFP. Statistical analysis showed significant differences for VAS on postoperative day 1 (p=0.004) and day 2 (p=0.005). Conclusions VAS assessment showed overall moderate perioperative morbidity in terms of donor site-related pain, which was reduced by administering ropivacaine.
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Ropars M, Zadem A, Morandi X, Kaila R, Guillin R, Huten D. How can we optimize anterior iliac crest bone harvesting? An anatomical and radiological study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 23:1150-5. [PMID: 24363041 DOI: 10.1007/s00586-013-3140-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 12/12/2013] [Accepted: 12/13/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE Anterior iliac crest bone is a widely used donor site for bone harvesting. It provides an autologous bone graft consisting of cancellous bone that can be packed or cortical bone with greater structural support. Uses include spinal fusion and fracture non-union surgery. Although its use is common, dedicated anatomical and radiological studies analysing graft dimensions and optimal harvesting site in relation to local anatomical landmarks [anterior superior iliac spine (ASIS), anterior iliac tubercle (AIT) and lateral femoral cutaneous nerve (LFCN)] have not been described. METHODS Twenty-eight female hemipelvises were dissected for this study. The LFCN, ASIS and AIT were identified. Calliper measurements and CT scan analysis were undertaken to determine the optimum positions in obtaining a 5-mm-thickness tricortical graft whilst remaining safe for the LFCN. RESULTS According to our measurements, the optimal location for harvesting a 5-mm-thick tricortical graft with 35-mm height and 47-mm width is situated anterior to a line passing at the level of the thickest point of the AIT. This thickest point was situated at a mean 67 mm from the centre of the EIAS in our study. CONCLUSION This anatomical and radiographic study determined the anatomical iliac crest landmarks to avoid neurological injury when taking an optimal 5-mm-width tricortical bone graft.
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Affiliation(s)
- Mickaël Ropars
- Anatomy Laboratory, Faculty of medicine of Rennes, 2 Avenue du Professeur Léon Bernard, 35043, Rennes, France,
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Sönmez TT, Prescher A, Salama A, Kanatas A, Zor F, Mitchell D, Zaker Shahrak A, Karaaltin MV, Knobe M, Külahci Y, Altuntas SH, Ghassemi A, Hölzle F. Comparative clinicoanatomical study of ilium and fibula as two commonly used bony donor sites for maxillofacial reconstruction. Br J Oral Maxillofac Surg 2013; 51:736-41. [DOI: 10.1016/j.bjoms.2013.07.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 07/25/2013] [Indexed: 11/27/2022]
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Zermatten P, Wettstein M. Iliac wing fracture following graft harvesting from the anterior iliac crest: literature review based on a case report. Orthop Traumatol Surg Res 2012; 98:114-7. [PMID: 22130003 DOI: 10.1016/j.otsr.2011.03.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2010] [Revised: 02/21/2011] [Accepted: 03/21/2011] [Indexed: 02/02/2023]
Abstract
The morbidity of bone graft harvesting from the iliac crest has been widely discussed in the literature. For some authors, it is considered to be low and for others relatively high. We report on a case of a fracture of the iliac wing after graft harvesting from the anterior iliac crest despite good surgical technique. This complication is well known and most of these fractures heal uneventfully if treated conservatively. However, if anatomical and technical considerations are respected, the patient could be spared this inconvenience. Based on a literature review, we discuss the procedure's potential complications and how to avoid them in an update.
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Affiliation(s)
- P Zermatten
- Department of Musculoskeletal Medicine, University of Lausanne, Lausanne, Switzerland.
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Risk of graft fracture after dorso-ventral thoraco-lumbar spondylodesis: is there a correlation with graft size? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 20:1644-9. [PMID: 21748494 DOI: 10.1007/s00586-011-1895-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Revised: 05/07/2011] [Accepted: 06/28/2011] [Indexed: 10/18/2022]
Abstract
STUDY DESIGN Retrospective clinical study in patients with dorso-ventral thoraco-lumbar spondylodesis. OBJECTIVE To investigate whether the ratio between graft cross sectional area and the surface area of the adjacent endplates has any effect on the midterm stability of the spondylodesis. Dorso-ventral spondylodesis in the region of the thoraco-lumbar spine is one of the most frequent operations in orthopaedic surgery. Anterior stabilization with autologous iliac crest graft currently is a standard approach in many hospitals. Although numerous recommendations are given how to perform this technique, no clinical advice is available with regard to minimum graft size. METHODS Sixty-four-slice CT-scans were obtained from 82 patients 4-12 months after posterior spondylodesis with anterior implantation of iliac crest graft and stabilization with an internal fixator. The scans were analyzed using image analysis software. First, the cross sectional area of the graft was calculated and then the surface area of the adjacent endplates. The ratio between graft cross sectional area and endplate surface area was then calculated from these two values. The grafts were then evaluated in sagittal reconstruction for signs of fracture. RESULTS The probability for graft fracture in autologous tricortical grafts was >0.1% (p < 0.001) if the graft cross sectional area exceeded 23.9% of the surface area of the adjacent endplates. Patients with lower ratio values had a higher fracture risk and below a value of 10% all grafts fractured. CONCLUSION The relationship between graft cross sectional area and adjacent endplate area has an important effect on graft midterm stability in ventral spondylodesis of the thoraco-lumbar spine. In our opinion, the risk of graft fractures in dorso-ventral spondylodesis can be reduced by implantation of an appropriately sized graft without any additional procedures or instrumentation.
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Silva RB, Cavali PTM, Veiga IG, Risso-Neto MI, Pasqualini W, Santos MAM, Rossato AJ, Lehoczki MA, Landim E. Avaliação da dor e morbidade local da retirada do enxerto ósseo da crista ilíaca para artrodese cervical anterior. COLUNA/COLUMNA 2010. [DOI: 10.1590/s1808-18512010000400014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: avaliar as possíveis complicações associadas à retirada de enxerto da crista ilíaca anterior em cirurgia para artrodese cervical anterior, em especial a dor residual. MÉTODOS: foi realizado estudo retrospectivo com análise de prontuários e aplicação de questionário via telefone com 20 pacientes no período compreendido entre Agosto de 2008 e Novembro de 2009. Todos os pacientes foram submetidos à mesma técnica cirúrgica para extração do enxerto, sendo operados pela mesma equipe no Hospital de Clinicas da Unicamp (HC Unicamp). As variantes analisadas foram dor residual, taxa de infecção, lesão neurológica ou vascular e ocorrência de fratura da asa do ilíaco. Os dados foram colocados em uma tabela e as médias e porcentagens foram calculadas. RESULTADOS: dos 20 pacientes, 12 homens e 8 mulheres, com média de idade de 51,75 anos (29-74) e follow-up médio de 11,83 meses (2-29), não houve nenhuma lesão grave, como fratura, lesão arterial ou neurológica. Houve um caso de infecção superficial (5%) e 25% dos pacientes queixaram-se de desconforto leve e dificuldade para deambular não incapacitante. CONCLUSÃO: a retirada de enxerto da crista ilíaca anterior está associada a muitas complicações, sendo importante o conhecimento de outras opções de enxerto e exposição ao paciente das possíveis complicações. Por meio deste levantamento, não verificamos nenhuma complicação grave, e o percentual de pacientes com dor residual acompanha os achados na literatura, podendo ser diminuído com uma dissecção cuidadosa da crista ilíaca.
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Affiliation(s)
- Rafael Barreto Silva
- Universidade Estadual de Campinas, Brasil; Associação de Assistência à Criança Deficiente, Brasil
| | - Paulo Tadeu Maia Cavali
- Universidade Estadual de Campinas, Brasil; Associação de Assistência à Criança Deficiente, Brasil
| | | | | | | | | | | | | | - Elcio Landim
- Associação de Assistência à Criança Deficiente, Brasil; Universidade Estadual de Campinas, Brasil
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Zouhary KJ. Bone Graft Harvesting From Distant Sites: Concepts and Techniques. Oral Maxillofac Surg Clin North Am 2010; 22:301-16, v. [DOI: 10.1016/j.coms.2010.04.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Shamsaldin M, Mouchaty H, Desogus N, Costagliola C, Di Lorenzo N. Evaluation of donor site pain after anterior iliac crest harvesting for cervical fusion: a prospective study on 50 patients. Acta Neurochir (Wien) 2006; 148:1071-4; discussion 1074. [PMID: 16932994 DOI: 10.1007/s00701-006-0864-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2005] [Accepted: 06/21/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Autologous anterior iliac crest bone graft is still widely considered the gold standard for anterior cervical fusion after discectomy or corporectomy. Postoperative pain at the donor site is one of the main disadvantages to this technique. This prospective study aimed to evaluate pain at the donor site, after careful, standardised bone harvesting. METHODS From March 2003 to March 2004, a prospective study was performed in a single neurosurgical department on 50 patients who underwent anterior iliac crest bone harvesting using a standard and careful surgical technique. During a one year follow-up, patient donor site pain was assessed with a Visual Analogous Scale (VAS) at 2, 7 and 60 days from surgery and finally, by a telephone interview, at one year. FINDINGS The duration of time in hospital ranged from 4 to 9 days. On the 2(nd) day after surgery, pain, according to the VAS score, was recorded as being >7 by 4 patients (8%), 5-7/10 by 27 patients and >5/10 in 19 cases. On the 7(th) day after surgery, none of the patients reported any VAS > 7, 1 patient's VAS score was 6/10 and 49 patients had a VAS < 5. At 2 month follow-up, 45 patients were completely without pain (VAS 0) and the remaining 5 had a VAS < 5. At one year, 46 patients reported no pain (one patient was lost to follow-up); three continued to have pain <5 in VAS scale. CONCLUSIONS After harvesting of bone from the iliac crest, using a standardised approach based on anatomised principles, most patients do not experience persisting pain at the donor site.
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Affiliation(s)
- M Shamsaldin
- Department of Neurosurgery, University of Florence, Florence, Italy
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Jäger M, Westhoff B, Wild A, Krauspe R. [Bone harvesting from the iliac crest]. DER ORTHOPADE 2006; 34:976-82, 984, 986-90, 992-4. [PMID: 16075252 DOI: 10.1007/s00132-005-0839-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Autogenous bone grafts from the iliac crest are frequently harvested for autologous bone transplantation. Although an autologous bone transplant does improve the local bone healing potency, significant donor site morbidity must be considered. METHODS In this study we elucidate special bone harvesting techniques from the iliac crest and review the literature related to clinical significance of donor site morbidity. Furthermore, our own experiences are compared and discussed critically with relevant data of other investigators. RESULTS The increasing number of scientific publications which focus on bone harvesting techniques and related complications in recent years indicate the high interest and relevance of this issue. There is a tendency to alternatives such as biomaterials as bone substitutes, whereas the role of growth factors and cell therapeutics in the treatment of bony defects are still being evaluated in clinical studies. CONCLUSION Although autologous, heterotopic bone transplantation is still the gold standard in the treatment of bony defects, there is a tendency towards the application of biomaterials, stem cells, and growth factors. Conscientious observation of relevant anatomic considerations during bone harvesting procedures may help to avoid complications.
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Affiliation(s)
- M Jäger
- Orthopädische Klinik, Heinrich-Heine-Universität, Düsseldorf
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Ito M, Abumi K, Moridaira H, Shono Y, Kotani Y, Minami A, Kaneda K. Iliac crest reconstruction with a bioactive ceramic spacer. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2005; 14:99-102. [PMID: 15241670 PMCID: PMC3476679 DOI: 10.1007/s00586-004-0765-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2003] [Revised: 05/21/2004] [Accepted: 05/28/2004] [Indexed: 11/24/2022]
Abstract
This study aimed to investigate the long-term clinical results of the apatite wollastonite-containing glass ceramic (AWGC) iliac spacer and to discuss its efficacy in reconstruction of the bone graft donor site at the iliac crest. Thirty-one patients were studied for more than 10 years. All patients underwent anterior spinal fusion using autogenous tricortical iliac bone graft. After harvest of tricortical iliac bone graft, an AWGC iliac spacer ranging from 15 mm to 70 mm in length was press-fitted into the gap. Long-term clinical results were obtained from radiological and blood examinations. Thirty patients (97%) were satisfied with the spacer. There was new bone formation around the spacer on the radiograph. There was no abnormal silicon concentration in blood examinations. AWGC iliac spacer appears to be useful in the reconstruction of harvested iliac crest. New bone formation occurs, reducing the defect size.
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Affiliation(s)
- Manabu Ito
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Kita-15 Nishi-7 Kita-ku, 060-8638, Sapporo, Japan.
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Zijderveld SA, ten Bruggenkate CM, van Den Bergh JPA, Schulten EAJM. Fractures of the iliac crest after split-thickness bone grafting for preprosthetic surgery: report of 3 cases and review of the literature. J Oral Maxillofac Surg 2004; 62:781-6. [PMID: 15218554 DOI: 10.1016/j.joms.2003.12.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE In this study fractures of the iliac crest after split-thickness bone grafting in a patient population treated for preprosthetic reasons were evaluated. PATIENTS AND METHODS In a retrospective patient population of 146 patients, during a 5-year period (1998 to 2002), 3 avulsion fractures of the iliac crest were noticed. All fractures were postsurgical, occurring as late fractures. A review of the literature regarding etiology, clinical characteristics, and results of treatment is given. RESULTS In all 3 cases treatment was conservative, consisting of a period of bed rest followed by progressive ambulation. Further recovery was uneventful. CONCLUSIONS According to this patient population and the literature, late fracture of the iliac crest after split-thickness bone grafting is an uncommon complication. We recommend a harvesting and grafting technique at an appropriate distance from the iliac spine with an oscillating saw. Treatment of an iliac crest fracture is almost always conservative.
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Affiliation(s)
- Steven A Zijderveld
- Department of Oral and Maxillofacial Surgery, Vrije Universiteit Medical Center, Academic Dentistry, Amsterdam.
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20
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Robertson PA, Rawlinson HJ, Hadlow AT. Radiologic Stability of Titanium Mesh Cages for Anterior Spinal Reconstruction Following Thoracolumbar Corpectomy. ACTA ACUST UNITED AC 2004; 17:44-52. [PMID: 14734976 DOI: 10.1097/00024720-200402000-00010] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This work evaluated the radiologic stability of titanium mesh cages (TMCs) when used for single-level corpectomy reconstruction of thoracic and thoracolumbar spine. METHODS Thirty-one patients underwent reconstruction for acute fractures (n = 15), posttraumatic deformity reconstruction (n = 10), neoplastic disorders (n = 4), and infection (n = 2). The cages were placed after corpectomy and excision of the adjacent intervertebral discs. Additional stabilization devices included anterior plates alone (n = 18), anterior double screw and rod constructs alone (n = 9), a single anterior rod system (n = 1), posterior stabilization alone (n = 6), and additional posterior stabilization (n = 2). RESULTS Mean kyphosis correction was from 16 degrees to 5 degrees with 3 degrees of recurrence at 1-year follow-up (P < 0.0001 for both postoperative and final follow-up). In patients with greater initial kyphosis (>20 degrees ), mean correction was from 33 degrees to 10 degrees without recurrence (P = 0.004). Distance between adjacent vertebral bodies improved by 13 mm after cage placement, with a mean of 2mm of settling at final follow-up. There was one asymptomatic cage fracture without evidence of other problems. Two patients had construct failure after complex three-dimensional deformities were inadequately corrected and the cages had been placed in an angulated position. CONCLUSIONS This report suggests that TMCs are a sound reconstruction alternative after thoracic and thoracolumbar corpectomy at a single level and may prevent complications associated with the harvest and use of large structural autografts for these reconstructions. Failure to correctly align the spine so the cage can be vertically placed is a contraindication to the use of TMCs.
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Ahlmann E, Patzakis M, Roidis N, Shepherd L, Holtom P. Comparison of anterior and posterior iliac crest bone grafts in terms of harvest-site morbidity and functional outcomes. J Bone Joint Surg Am 2002; 84:716-20. [PMID: 12004011 DOI: 10.2106/00004623-200205000-00003] [Citation(s) in RCA: 443] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Previous studies have demonstrated high complication rates after harvest of iliac crest bone grafts. This study was undertaken to compare the morbidity related to the harvest of anterior iliac crest bone graft with that related to the harvest of posterior iliac crest bone graft and to determine differences in functional outcome. METHODS The medical records of eighty-eight consecutive patients who had undergone a total of 108 iliac crest bone-grafting procedures for the treatment of chronic osteomyelitis from 1991 to 1998 were retrospectively reviewed. Demographic characteristics, the location of the harvest, the volume of bone graft that was harvested, the estimated blood loss, and postoperative complications were recorded. Fifty-eight patients completed a questionnaire pertaining to postoperative and residual pain, sensory disturbances, functional limitations, cosmetic appearance, and overall satisfaction with the bone-graft harvesting procedure. RESULTS Sixty-six anterior and forty-two posterior bone-graft harvest sites were evaluated at a minimum of two years after the operation. A major complication was associated with 8% (five) of the sixty-six anterior sites and 2% (one) of the forty-two posterior sites. The rates of minor complications were 15% (ten) and 0%, respectively. In the series as a whole, there were ten minor complications (9%) and six major complications (6%). The rates of both minor complications (p = 0.006) and all complications (p = 0.004) were significantly higher after the anterior harvest procedures than they were after the posterior procedures. The postoperative pain at the donor site was significantly more severe (p = 0.0016) and of significantly greater duration (p = 0.0017) after the anterior harvests. No patient reported functional limitations at the latest follow-up evaluation. CONCLUSIONS In this series, the complication rate was lower than those previously reported by other investigators. Harvest of a posterior iliac crest bone graft was associated with a significantly lower risk of postoperative complications. On the basis of the results of this study, we recommend that iliac crest bone graft be harvested posteriorly whenever possible.
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Affiliation(s)
- Elke Ahlmann
- Department of Orthpaedics, Keck School of Medicine, University of Southern California, Los Angeles 90033-4608, USA
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Heary RF, Schlenk RP, Sacchieri TA, Barone D, Brotea C. Persistent Iliac Crest Donor Site Pain: Independent Outcome Assessment. Neurosurgery 2002. [DOI: 10.1227/00006123-200203000-00015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Heary RF, Schlenk RP, Sacchieri TA, Barone D, Brotea C. Persistent iliac crest donor site pain: independent outcome assessment. Neurosurgery 2002; 50:510-6; discussion 516-7. [PMID: 11841718 DOI: 10.1097/00006123-200203000-00015] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This study objectively defines the incidence of donor site pain in an independent outcome analysis. In addition, this study identifies the significant discrepancies that are observed when independent outcome assessment results are compared with the incidences determined by review of the operating surgeon's documented findings. METHODS A review of patients who underwent iliac bone graft harvesting by a single neurosurgeon was conducted. The presence of iliac crest donor site pain, at a time remote from surgery, as determined by specific questioning and recorded in the neurosurgeon's written evaluation was compared with independent assessment findings obtained in structured telephone questionnaire interviews. During a 4-year period, 105 patients met the inclusion criteria. Both the operating surgeon' and independent interviewer's follow-up evaluations were completed for all study patients. Pain was classified into three categories, i.e., no pain, acceptable pain, or unacceptable pain. Patients were also asked to assess the severity of their donor site pain by using a visual analog scale. Statistical analyses comparing the incidences of iliac crest donor site pain in the operating surgeon's evaluations and the independent assessments were performed. RESULTS When evaluated at a time remote from surgery, the true incidence of iliac crest donor site pain after graft harvest procedures (34%) was significantly greater than previously appreciated by the neurosurgeon (8%). Although occasional or mild pain was observed for 31% of patients, only 3% of all patients experienced unacceptable pain. CONCLUSION Independent outcome assessment values should be provided to patients in preoperative discussions regarding donor site morbidity. Objective outcome analysis, based on independent observations, is crucial for the most accurate interpretation of perceptions of iliac crest donor site pain.
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Affiliation(s)
- Robert F Heary
- Department of Neurosurgery, Neurological Institute of New Jersey, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jersey, USA.
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Ebraheim NA, Elgafy H, Xu R. Bone-graft harvesting from iliac and fibular donor sites: techniques and complications. J Am Acad Orthop Surg 2001; 9:210-8. [PMID: 11421578 DOI: 10.5435/00124635-200105000-00007] [Citation(s) in RCA: 155] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The ilium and the fibula are the most common sites for bone-graft harvesting. The different methods for harvesting iliac bone graft include curettage, trapdoor or splitting techniques for cancellous bone, and the subcrestal-window technique for bicortical graft. A tricortical graft from the anterior ilium should be taken at least 3 cm posterior to the anterior superior iliac spine (ASIS). Iliac donor-site complications include pain, neurovascular injury, avulsion fractures of the ASIS, hematoma, infection, herniation of abdominal contents, gait disturbance, cosmetic deformity, violation of the sacroiliac joint, and ureteral injury. The neurovascular structures at risk for injury during iliac bone-graft harvesting include the lateral femoral cutaneous, iliohypogastric, and ilioinguinal nerves anteriorly and the superior cluneal nerves and superior gluteal neurovascular bundle posteriorly. Violation of the sacroiliac joint can be avoided by limiting the harvested area to 4 cm from the posterior superior iliac spine (PSIS) and by not penetrating the inner cortex. The caudal limit for bone harvesting should be the inferior margin of the roughened area anterior to the PSIS on the outer table to keep from injuring the superior gluteal artery. Potential complications of fibular graft harvesting include neurovascular injury, compartment syndrome, extensor hallucis longus weakness, and ankle instability. The neurovascular structures at risk for injury during fibular bone-graft harvesting include the peroneal nerves and their muscular branches in the proximal third of the fibular shaft and the peroneal vessels in the middle third.
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Affiliation(s)
- N A Ebraheim
- Department of Orthopaedic Surgery, Medical College of Ohio, 3000 Arlington Avenue, Toledo, OH 43699, USA
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