Skip to main content
SpringerLink
Log in

Anatomic feasibility of a new endopelvic approach for iliac crest bone harvesting

  • Original Article
  • Published:
Surgical and Radiologic Anatomy Aims and scope Submit manuscript

Abstract

Purpose

For the past few years, anterior exposure for surgery of the lumbar spine has gained popularity for the treatment of disk disease or spondylosis. Cancellous bone remains the gold standard for fusion. Iliac crest bone harvesting is safe but there are donor site complications. Bone substitutes exist, like recombinant human bone morphogenic protein-2 rhBMP-2. This alternative offers a high rate of fusion but with local and general complications. The aim of our study is to show the feasibility of an endopelvic approach for iliac bone crest harvesting to avoid donor site complication.

Method

Twenty anterior retroperitoneal lumbar spine approaches have been realized in the anatomy department of the University of Bordeaux. The volumes of cancellous bone have been measured and procedure complications have been reported.

Results

The mean volume of cancellous bone was 5.9 cc, the maximum volume was 8.2 cc and the minimum volume was 4.5 cc. No complications have been reported during the approach or the bone harvesting.

Conclusions

Anterior retroperitoneal approach for iliac bone crest harvesting is a safe way to obtain sufficient volume of cancellous bone for a single lumbar spinal fusion. This exposure avoids the risks of an iliac crest donor site complications or rhBMP-2 complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. 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 100:600–604

    Article  CAS  PubMed  Google Scholar 

  2. Baker JK, Reardon PR, Reardon MJ, Heggeness MH (1993) Vascular injury in anterior lumbar surgery. Spine 18:2227–2230

    Article  CAS  PubMed  Google Scholar 

  3. Boden SD, Kang J, Sandhu H, Heller JG (2002) Use of recombinant human bone morphogenetic protein-2 to achieve posterolateral lumbar spine fusion in humans: a prospective, randomized clinical pilot trial: 2002 Volvo Award in clinical studies. Spine 27:2662–2673. doi:10.1097/01.BRS.0000035320.82533.06

    Article  PubMed  Google Scholar 

  4. Carragee EJ, Hurwitz EL, Weiner BK (2011) A critical review of recombinant human bone morphogenetic protein-2 trials in spinal surgery: emerging safety concerns and lessons learned. Spine J 11:471–491. doi:10.1016/j.spinee.2011.04.023

    Article  PubMed  Google Scholar 

  5. Carragee EJ, Mitsunaga KA, Hurwitz EL, Scuderi GJ (2011) Retrograde ejaculation after anterior lumbar interbody fusion using rhBMP-2: a cohort controlled study. Spine J 11:511–516. doi:10.1016/j.spinee.2011.02.013

    Article  PubMed  Google Scholar 

  6. Dimitriou R, Mataliotakis GI, Angoules AG, Kanakaris NK, Giannoudis PV (2011) Complications following autologous bone graft harvesting from the iliac crest and using the RIA: a systematic review. Injury 42(Suppl 2):S3–S15. doi:10.1016/j.injury.2011.06.015

    Article  PubMed  Google Scholar 

  7. Fu R, Selph S, McDonagh M, Peterson K, Tiwari A, Chou R, Helfand M (2013) Effectiveness and harms of recombinant human bone morphogenetic protein-2 in spine fusion: a systematic review and meta-analysis. Ann Intern Med 158:890–902. doi:10.7326/0003-4819-158-12-201306180-00006

    Article  PubMed  Google Scholar 

  8. Galimberti F, Lubelski D, Healy AT, Wang T, Abdullah KG, Nowacki AS, Benzel EC, Mroz TE (2015) A systematic review of lumbar fusion rates with and without the use of rhBMP-2. Spine. doi:10.1097/BRS.0000000000000971

    PubMed  Google Scholar 

  9. Garg J, Woo K, Hirsch J, Bruffey JD, Dilley RB (2010) Vascular complications of exposure for anterior lumbar interbody fusion. J Vasc Surg 51:946–950. doi:10.1016/j.jvs.2009.11.039 discussion 950

    Article  PubMed  Google Scholar 

  10. Hernigou J, Picard L, Alves A, Silvera J, Homma Y, Hernigou P (2014) Understanding bone safety zones during bone marrow aspiration from the iliac crest: the sector rule. Int Orthop 38:2377–2384. doi:10.1007/s00264-014-2343-9

    Article  PubMed  Google Scholar 

  11. Hodgson AR, Stock FE (1994) Anterior spinal fusion. A preliminary communication on the radical treatment of Pott’s disease and Pott’s paraplegia. 1956. Clin Orthop Relat Res (300):16–23

  12. Hu RW, Bohlman HH (1994) Fracture at the iliac bone graft harvest site after fusion of the spine. Clin Orthop Relat Res (309):208–213

  13. Kim DH, Rhim R, Li L, Martha J, Swaim BH, Banco RJ, Jenis LG, Tromanhauser SG (2009) Prospective study of iliac crest bone graft harvest site pain and morbidity. Spine J 9:886–892. doi:10.1016/j.spinee.2009.05.006

    Article  PubMed  Google Scholar 

  14. Lee K-B, Taghavi CE, Hsu MS, Song K-J, Yoo JH, Keorochana G, Ngo SS, Wang JC (2010) The efficacy of rhBMP-2 versus autograft for posterolateral lumbar spine fusion in elderly patients. Eur Spine J 19:924–930. doi:10.1007/s00586-009-1248-6

    Article  PubMed  Google Scholar 

  15. Mahato NK (2011) Characterization of cortico-cancellous bone along the iliac crest: focus on graft harvesting. Surg Radiol Anat SRA 33:433–437. doi:10.1007/s00276-010-0752-z

    Article  PubMed  Google Scholar 

  16. Marchesi DG (2000) Spinal fusions: bone and bone substitutes. Eur Spine J 9:372–378

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Ropars M, Zadem A, Morandi X, Kaila R, Guillin R, Huten D (2014) How can we optimize anterior iliac crest bone harvesting? An anatomical and radiological study. Eur Spine J 23:1150–1155. doi:10.1007/s00586-013-3140-7

    Article  PubMed  Google Scholar 

  18. Sen MK, Miclau T (2007) Autologous iliac crest bone graft: should it still be the gold standard for treating nonunions? Injury 38(Suppl 1):S75–S80. doi:10.1016/j.injury.2007.02.012

    Article  PubMed  Google Scholar 

  19. 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 (Wien) 148:1071–1074. doi:10.1007/s00701-006-0864-8 discussion 1074

    Article  CAS  Google Scholar 

  20. Singh K, Ahmadinia K, Park DK, Nandyala SV, Marquez-Lara A, Patel AA, Fineberg SJ (2014) Complications of spinal fusion with utilization of bone morphogenetic protein: a systematic review of the literature. Spine 39:91–101. doi:10.1097/BRS.0000000000000004

    Article  PubMed  Google Scholar 

  21. Southwick WO, Robinson RA (1957) Surgical approaches to the vertebral bodies in the cervical and lumbar regions. J Bone Joint Surg Am 39-A:631–644

    Article  CAS  PubMed  Google Scholar 

  22. Vaccaro AR, Chiba K, Heller JG, Patel TC, Thalgott JS, Truumees E, Fischgrund JS, Craig MR, Berta SC, Wang JC, North American Spine Society for Contemporary Concepts in Spine Care (2002) Bone grafting alternatives in spinal surgery. Spine J Soc 2:206–215

    Article  Google Scholar 

  23. Vavken J, Mameghani A, Vavken P, Schaeren S (2015) Complications and cancer rates in spine fusion with recombinant human bone morphogenetic protein-2 (rhBMP-2). Eur Spine J. doi:10.1007/s00586-015-3870-9

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Regional Spine Institute, University Hospital of Rouen, Rue de Germont, 76000, Rouen, France

    S. Le Pape

  2. Urology Department, University Hospital of Rouen, Rouen, France

    L. Du Pouget

  3. Spine Unit 1, University Hospital Pellegrin, Bordeaux, France

    T. Cloche, M. Campana, I. Obeid, L. Boissiere & J.-M. Vital

Authors
  1. S. Le Pape
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. Du Pouget
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. T. Cloche
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Campana
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. I. Obeid
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. L. Boissiere
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J.-M. Vital
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Le Pape.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Le Pape, S., Du Pouget, L., Cloche, T. et al. Anatomic feasibility of a new endopelvic approach for iliac crest bone harvesting. Surg Radiol Anat 38, 1191–1194 (2016). https://doi.org/10.1007/s00276-016-1686-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00276-016-1686-x

Keywords

Search

Navigation