HSS Journal

, Volume 5, Issue 2, pp 114–116 | Cite as

Spontaneous Posterior Iliac Crest Regeneration Enabling Second Bone Graft Harvest; A Case Report

  • Elias C. Papadopoulos
  • Patrick F. O’Leary
  • Ioannis P. Pappou
  • Federico P. Girardi
Case Report

Abstract

We present a case of a revision spinal fusion in which successful bone graft reharvesting was performed from the posterior iliac crest 4 years after initial intracortical harvesting. To date, only anterior iliac crest regeneration has been reported in orthopedic trauma patients. A 70-year-old man with a history of two prior instrumented lumbar fusion operations developed thoracolumbar kyphosis junctional to the lumbosacral fusion mass. His first operation was an instrumented posterolateral lumbar fusion L1 to L5, where bone graft was harvested from the right iliac crest using the intracortical harvesting technique. The second procedure was performed 18 months later and consisted of an extension of the fusion to the sacrum due to L5–S1 level derived symptoms. The bone graft for this procedure was taken with the same technique from the left iliac crest. The development of thoracolumbar junctional kyphosis necessitated the third operation, which consisted of a same-day anterior–posterior extension of the fusion to T10. Prior to this third procedure, a spinal computer tomography was performed that documented regeneration of the cancellous bone in the right iliac crest. This permitted reharvesting of almost 40 ml of cancellous bone using the intracortical bone harvesting technique from the right iliac crest. Histological analysis showed mature bone. Cancellous bone regeneration and restoration of the local anatomy of the ilium are possible after intracortical bone harvesting. This regeneration can provide autologous bone graft to assist fusion in subsequent operations.

Keywords

posterior iliac crest bone graft intracortical technique bone harvesting reharvesting complications 

References

  1. 1.
    Jorgenson SS, Lowe TG, France J, Sabin J, A prospective analysis of autograft versus allograft in posterolateral lumbar fusion in the same patient. A minimum of 1-year follow-up in 144 patients. Spine 1994; 19(18): 2048–2053PubMedCrossRefGoogle Scholar
  2. 2.
    Moed BR, Thorderson N, Linden MD, Reharvest of iliac crest donor site cancellous bone. Clin. Orthop. 1998; (346): 223–227Google Scholar
  3. 3.
    Montgomery DM, Moed BR, Cancellous bone donor site regeneration. J. Orthop. Trauma 1989; 3(4): 290–294PubMedCrossRefGoogle Scholar
  4. 4.
    Shin AY, Moran ME, Wenger DR, Superior gluteal artery injury secondary to posterior iliac crest bone graft harvesting. A surgical technique to control hemorrhage. Spine 1996; 21: 1371–1374PubMedCrossRefGoogle Scholar
  5. 5.
    Lim EV, Lavadia WT, Roberts JM, Superior gluteal artery injury during iliac bone grafting for spinal fusion. A case report and literature review. Spine 1996; 21: 2376–2378PubMedCrossRefGoogle Scholar
  6. 6.
    Summers BN, Eisenstein SM, Donor site pain from the ilium. A complication of lumbar spine fusion. J. Bone Joint Surg. Br 1989; 71(4): 677–680PubMedGoogle Scholar
  7. 7.
    Kurz LT, Garfin SR, Booth RE Jr, Harvesting autogenous iliac bone grafts. A review of complications and techniques. Spine 1989; 14(12): 1324–1331PubMedCrossRefGoogle Scholar
  8. 8.
    Porchet F, Jaques B, Unusual complications at iliac crest bone graft donor site: experience with two cases. Neurosurgery 1996; 39: 856–859PubMedCrossRefGoogle Scholar
  9. 9.
    Coventry MB, Tapper EM, Pelvic instability: a consequence of removing iliac bone for grafting. J. Bone Joint Surg. Am 1972; 54(1): 83–101PubMedGoogle Scholar
  10. 10.
    Ebraheim NA, Elgafy H, Semaan HB, Computed tomographic findings in patients with persistent sacroiliac pain after posterior iliac graft harvesting. Spine 2000; 25(16): 2047–2051PubMedCrossRefGoogle Scholar
  11. 11.
    Mirovsky Y, Neuwirth MG, Comparison between the outer table and intracortical methods of obtaining autogenous bone graft from the iliac crest. Spine 2000; 25(13): 1722–1725PubMedCrossRefGoogle Scholar
  12. 12.
    Weinstein JN, The intracortical method of bone harvesting from the iliac crest did not reduce pain or bleeding at the donor site. J. Bone Joint Surg. Am 2000; 82-A(12): 1809PubMedGoogle Scholar

Copyright information

© Hospital for Special Surgery 2009

Authors and Affiliations

  • Elias C. Papadopoulos
    • 1
    • 2
  • Patrick F. O’Leary
    • 2
  • Ioannis P. Pappou
    • 2
    • 3
  • Federico P. Girardi
    • 2
  1. 1.University of Athens, School of MedicineOrthopedic Department, Spine ServiceAthensGreece
  2. 2.Spine ServiceHospital for Special SurgeryNew YorkUSA
  3. 3.Department of Orthopedic SurgeryUniversity of KentuckyLexingtonUSA

Personalised recommendations