Iliac Crest Bone Graft Harvest and Fusion Techniques

Approximately 250,000 bone grafting procedures are performed annually in the United States for spinal surgery. Anterior and posterior autologous iliac crest bone grafts (A/PICG) are commonly used in spinal surgery for spinal reconstruction and to obtain fusion. The clinical outcome of autologous iliac crest bone graft usage is more predictable compared to other grafting materials, including allograft, xenograft, and synthetic materials. The basic principles of an anterior cervical discectomy (ACD) or corpectomy (ACC) and fusion procedure includes decompression followed by restoration of the anterior column with a structural graft to achieve a biologic bony union. A structural cortical autologous bone graft has intrinsic stability and provides support while autologous cancellous bone provides cells and protein important for fusion success and a substrate for osteoconduction. However, it contributes no biologic support or structural stability. Autologous cancellous bone is frequently harvested from either the anterior or posterior iliac crest and is placed either anteriorly in a structural cage or posteriorly along the posterolateral cerical masses or intertransverse processes.