Anterior iliac crest bone graft: Anatomic considerations
Department of Orthopaedic Surgery, Medical College of Ohio, Toledo, USA. Spine
(Impact Factor: 2.3).
05/1997; 22(8):847-9. DOI: 10.1097/00007632-199704150-00003
A morphologic study of the anterior part of the iliac crest was performed.
To define the anatomic characteristics of the anterior part of the ilium and to determine an optimal area to harvest the iliac bone graft from the anterior iliac crest.
Stress fracture or avulsion fracture of the anterior cut for anterior iliac crest graft have been noted previously. However, there is insufficient published information on the morphology of the anterior part of the ilium relative to the optimal location of harvesting the bone graft.
Direct measurements using digital calipers were taken from 30 dried human pelves and 10 cadaveric pelves. The thickness of the anterior part of the ilium was measured, with different starting points on the iliac crest. The length of the bicortical iliac bone graft also was determined.
The thickest portion of the ilium was 18.9 +/- 2.3 mm at the iliac tubercle, which was 45% thicker than at a point 3 cm posterior to the anterior superior iliac spine. The thick region of the anterior iliac crest extended 54.0 +/- 10.2 mm posteriorly from a point 3 cm posterior to the anterior superior iliac spine. The mean length of a 10 mm thick bicortical iliac tubercle bone graft was 36.8 +/- 8.7 mm.
The region around the iliac tubercle is suitable for harvesting bicortical or tricortical bone graft.
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ABSTRACT: Autogenous bone grafts are frequently harvested for the purposes of bone union and stability. Ilium is the most common site for bone-graft harvesting. Although some donor site complications may be unavoidable, awareness of the anatomy and complications may aid in planning the approach and minimizing the risks. A tricortical graft from the anterior ilium should be taken at least 2 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 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. Strict observation of relevant anatomic considerations will help in avoiding these complications.
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ABSTRACT: Objective. It is widely believed that combined dorso-ventral stabilization provides superior mechanic stability in the operative treatment of thoracolumbar spine fractures. Currently there are no data available reflecting the fusion rates in trauma patients following the combined procedure. Aim of this investigation was to study the fusion rates following dorso-ventral stabilization of thoracolumbar spine fractures and the rates of local complications at the donor site.
Methods. In order to assess fusion and complication rates 30 patients with unstable fractures of the thoracolumbar spine were selected from a consecutive series and investigated in a prospective study.After posterior stabilization with a fixateur interne (USS, Synthes) anterior arthrodesis was performed subsequently by autogenous iliac bone grafting in combination with an osteosynthesis (MACS,Aesculap;VentroFix, Synthes). The osseous integration of the autogenous transplants was measured by CT-scan 12±2.4 months after surgery.
Results. The evaluation of the radiographic and CT data revealed a fusion rate of 77% (23/30) one year after surgery.These findings were accompanied by minor complications at the donor site in 37% (11/30).
Conclusion. Our experiences with autogenous spine grafting gave evidence that a reliable osseus integration can not be expected in all of the cases.Furthermore one has to consider a high rate of local complications. Therefore alternative procedures such as the use of cages will be of increasing influence in the surgical treatment of thoracolumbar spine fractures.
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ABSTRACT: This work evaluated the radiologic stability of titanium mesh cages (TMCs) when used for single-level corpectomy reconstruction of thoracic and thoracolumbar spine.
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).
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.
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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