Top

European Spine Journal

Published in:

01-05-2014 | Original Article

How can we optimize anterior iliac crest bone harvesting? An anatomical and radiological study

Authors: Mickaël Ropars, Alexandre Zadem, Xavier Morandi, Rajiv Kaila, Raphaël Guillin, Denis Huten

Published in: European Spine Journal | Issue 5/2014

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.

Abramowicz S, Katsnelson A, Forbes PW, Padwa BL (2012) Anterior versus posterior approach to iliac crest for alveolar cleft bone grafting. J Oral Maxillofac Surg 70:211–215PubMedCrossRef

Adeyemo WL (2004) Bone grafts for jaw augmentation procedures: anterior versus posterior iliac crest. Int J Oral Maxillofac Surg 33:816PubMedCrossRef

Ahlmann E, Patzakis M, Roidis N, Shepherd L, Holtom P (2002) Comparison of anterior and posterior iliac crest bone grafts in terms of harvest-site morbidity and functional outcomes. J Bone Joint Surg Am 84:716–720PubMedCrossRef

Aldrich EF, van den Heever CM (1989) Suprainguinal ligament approach for surgical treatment of meralgia paresthetica. Technical note. J Neurosurg 70:492–494PubMedCrossRef

Aszmann OC, Dellon ES, Dellon AL (1997) Anatomical course of the lateral femoral cutaneous nerve and its susceptibility to compression and injury. Plast Reconstr Surg 100:600–604PubMedCrossRef

Banwart JC, Asher MA, Hassanein RS (1995) Iliac crest bone graft harvest donor site morbidity. A statistical evaluation. Spine 20:1055–1060PubMedCrossRef

Baqain ZH, Anabtawi M, Karaky AA, Malkawi Z (2009) Morbidity from anterior iliac crest bone harvesting for secondary alveolar bone grafting: an outcome assessment study. J Oral Maxillofac Surg 67:570–575PubMedCrossRef

Barone A, Ricci M, Mangano F, Covani U (2011) Morbidity associated with iliac crest harvesting in the treatment of maxillary and mandibular atrophies: a 10-year analysis. J Oral Maxillofac Surg 69:298–304CrossRef

Behairy YM, Al-Sebai W (2001) A modified technique for harvesting full-thickness iliac crest bone graft. Spine 26:695–697PubMedCrossRef

10.

DeOrio JK, Farber DC (2005) Morbidity associated with anterior iliac crest bone grafting in foot and ankle surgery. Foot Ankle Int 26:147–151PubMed

11.

Dhawan A, Kuklo TR, Polly DW Jr (2006) Analysis of iliac crest bone grafting process measures. Am J Orthop 35:322–326PubMed

12.

Dias Filho LC, Valença MM, Guimarães Filho FA, Medeiros RC, Silva RA, Morais MG, Valente FP, França SM (2003) Lateral femoral cutaneous neuralgia: an anatomical insight. Clin Anat 16:309–316PubMedCrossRef

13.

Dibenedetto LM, Lei Q, Gilroy AM, Hermey DC, Marks SC Jr, Page DW (1996) Variations in the inferior pelvic pathway of the lateral femoral cutaneous nerve: implications for laparoscopic hernia repair. Clin Anat 9:232–236PubMedCrossRef

14.

Ebraheim NA, Yang H, Lu J, Biyani A, Yeasting RA (1997) Anterior iliac crest bone graft. Anatomic considerations. Spine 22:847–849PubMedCrossRef

15.

Engelstad ME, Morse T (2010) Anterior iliac crest, posterior iliac crest, and proximal tibia donor sites: a comparison of cancellous bone volumes in fresh cadavers. J Oral Maxillofac Surg 68:3015–3021PubMedCrossRef

16.

Fasolis M, Boffano P, Ramieri G (2012) Morbidity associated with anterior iliac crest bone graft. Oral Surg Oral Med Oral Pathol Oral Radiol 114:586–591PubMedCrossRef

17.

Hospodar PP, Ashman ES, Traub JA (1999) Anatomic study of the lateral femoral cutaneous nerve with respect to the ilioinguinal surgical dissection. J Orthop Trauma 13:17–19PubMedCrossRef

18.

Hu R, Hearn T, Yang J (1995) Bone graft harvest site as a determinant of iliac crest strength. Clin Orthop 310:252–256PubMed

19.

Hwang K, Nam YS, Kim DJ, Han SH, Hwang SH (2007) Could skin retraction incision minimize nerve injury over the iliac crest? J Craniofac Surg 18:1447–1450PubMedCrossRef

20.

Khamanarong K, Kosuwon W, Sirichativapee W, Saejung S, Thepsuthammarat K (2005) Thicknesses of the iliac crest appropriate for anterior cervical interbody fusion grafts. J Med Assoc Thai 88:1892–1895PubMed

21.

Kurz LT, Garfin SR, Booth RE Jr (1989) Harvesting autogenous iliac bone grafts. A review of complications and techniques. Spine 14:1324–1331PubMedCrossRef

22.

Letournel E, Judet R, Elson RA (1993) Fractures of the acétabulum, 2nd edn. Springer, BerlinCrossRef

23.

Mahato NK (2011) Characterization of cortico-cancellous bone along the iliac crest: focus on graft harvesting. Surg Radiol Anat 33:433–437PubMedCrossRef

24.

Matsa S, Murugan S, Kannadasan K (2012) Evaluation of morbidity associated with iliac crest harvest for alveolar cleft bone grafting. J Maxillofac Oral Surg 11:91–95PubMedCentralPubMedCrossRef

25.

Matteo MT, Simone S, Francesco DN, Alessandro M, Enrico F, Giulio G, Sandro P (2013) Intracortical versus anteromedial approach for iliac crest bone harvesting in preprosthetic surgery: a randomized prospective clinical trial. J Craniofac Surg 24:369–372PubMedCrossRef

26.

Mirovsky Y, Neuwirth M (2000) Injuries to the lateral femoral cutaneous nerve during spine surgery. Spine 25:1266–1269PubMedCrossRef

27.

Mischkowski RA, Selbach I, Neugebauer J, Koebke J, Zöller JE (2006) Lateral femoral cutaneous nerve and iliac crest bone grafts––anatomical and clinical considerations. Int J Oral Maxillofac Surg 35:366–372PubMedCrossRef

28.

Missiuna PC, Gandhi HS, Farrokhyar F, Harnett BE, Dore EM, Roberts B (2011) Anatomically safe and minimally invasive transcrestal technique for procurement of autogenous cancellous bone graft from the mid-iliac crest. Can J Surg 54:327–332PubMedCentralPubMedCrossRef

29.

Murata Y, Takahashi K, Yamagata M, Shimada Y, Moriya H (2000) The anatomy of the lateral femoral cutaneous nerve, with special reference to the harvesting of iliac bone graft. J Bone Joint Surg Am 82:746–747PubMed

30.

Murata Y, Takahashi K, Yamagata M, Sameda H, Moriya H (2002) Injury to the lateral femoral cutaneous nerve during harvest of iliac bone graft, with reference to the size of the graft. J Bone Joint Surg Br 84:798–801PubMedCrossRef

31.

Nkenke E, Weisbach V, Winckler E, Kessler P, Schultze-Mosgau S, Wiltfang J, Neukam FW (2004) Morbidity of harvesting of bone grafts from the iliac crest for preprosthetic augmentation procedures: a prospective study. Int J Oral Maxillofac Surg 33:157–163PubMedCrossRef

32.

Pollock R, Alcelik I, Bhatia C, Chuter G, Lingutla K, Budithi C, Krishna M (2008) Donor site morbidity following iliac crest bone harvesting for cervical fusion: a comparison between minimally invasive and open techniques. Eur Spine J 17:845–852PubMedCentralPubMedCrossRef

33.

de Ridder VA, de Lange S, Popta JV (1999) Anatomical variations of the lateral femoral cutaneous nerve and the consequences for surgery. J Orthop Trauma 13:207–211PubMedCrossRef

34.

Ropars M, Morandi X, Huten D, Thomazeau H, Berton E, Darnault P (2009) Anatomical study of the lateral femoral cutaneous nerve with special reference to minimally invasive anterior approach for total hip replacement. Surg Radiol Anat 31:199–204PubMedCrossRef

35.

Shamsaldin M, Mouchaty H, Desogus N, Costagliola C, Di Lorenzo N (2006) Evaluation of donor site pain after anterior iliac crest harvesting for cervical fusion: a prospective study on 50 patients. Acta Neurochir 148:1071–1074PubMedCrossRef

36.

Skeppholm M, Olerud C (2013) Pain from donor site after anterior cervical fusion with bone graft: a prospective randomized study with 12 months of follow-up. Eur Spine J 22:142–147PubMedCentralPubMedCrossRef

37.

Spallone A (2007) A less-invasive technique for harvesting autologous iliac crest grafts for cervical interbody fusion: technical note. Surg Neurol 67:160–162PubMedCrossRef

38.

Sürücü HS, Tanyeli E, Sargon MF, Karahan ST (1997) An anatomic study of the lateral femoral cutaneous nerve. Surg Radiol Anat 19:307–310PubMedCrossRef

39.

Williams PH, Trzil KP (1991) Management of meralgia paresthetica. J Neurosurg 74:76–80PubMedCrossRef

40.

Yang SH, Wu CC, Chen PQ (2005) Postoperative meralgia paresthetica after posterior spine surgery: incidence, risk factors, and clinical outcomes. Spine 30:547–550CrossRef

41.

Zermatten P, Wettstein M (2012) Iliac wing fracture following graft harvesting from the anterior iliac crest: literature review based on a case report. Orthop Traumatol Surg Res 98:114–117PubMedCrossRef

Title: How can we optimize anterior iliac crest bone harvesting? An anatomical and radiological study
Authors: Mickaël Ropars
Alexandre Zadem
Xavier Morandi
Rajiv Kaila
Raphaël Guillin
Denis Huten
Publication date: 01-05-2014
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 5/2014
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-013-3140-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

How can we optimize anterior iliac crest bone harvesting? An anatomical and radiological study

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 5/2014

Should age be a contraindication for degenerative lumbar surgery?

Can unilateral-approach minimally invasive transforaminal lumbar interbody fusion attain indirect contralateral decompression? A preliminary report of 66 MRI analysis

Computed tomography-based classification of axis vertebra: choice of screw placement

Identification of intervertebral disc regeneration with magnetic resonance imaging after a long-term follow-up in patients treated with percutaneous diode laser nucleoplasty: a retrospective clinical and radiological analysis of 14 patients

Spinal canal morphology and clinical outcomes of microsurgical bilateral decompression via a unilateral approach for lumbar spinal canal stenosis

Comparison of unilateral versus bilateral pedicle screw fixation in degenerative lumbar diseases: a meta-analysis