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Iliac Crest Autograft Techniques

Harvesting bone from a patient's own iliac crest is the best option for fusion surgery. It is the most widely used autograft, causing the least chance of rejection by the body. Orthopedic surgeons use the iliac bone to fill empty spaces left from the removal of bulging disc material during discectomies and fractures. Failure to follow the proper techniques in harvesting bone from the iliac crest can cause fracture, infection and nerve damage according to a published journal in PubMed in 2007.

  1. Anatomy

    • The iliac crest is located at the top of the ileum, known to laypeople as the pelvis. The crest is rounded and thick, making it a popular donor site for fusion surgery. It is easy to access and recovery is usually uneventful. The bone graft is inserted in between two vertebrae in the spine and secured with pins, plates and screws. The bone graft is shaped with orthopedic tools to fit operative site.

    Techniques

    • A danger that is apparent in harvesting bone from the iliac crest is possible injury to the sacroiliac joint from the use of osteotomes, instruments used to cut away bone. In a study conducted by Ebraheim NA, the use of osteotomes caused injury in 15 out of 24 patients. The use of the osteotome may cause weakness in the graft. An oscillating saw is recommended in place of osteotomes as reported in the Internet Journal of Orthopedic Surgery. Bone infection is a concern when using bone wax and taking into consideration the closeness of the perineum area to the surgical site. Nerve injury is another concern, especially the cutaneous nerve around the iliac crest. Care must be taken not to injure the nerve through retracting equipment and manipulation. According to a Duke University report on harvesting bone graft around the iliac crest, after the incision is made, palpate the area around the greater sciatic notch for the gluteus maximumus artery. Secure the artery to avoid complications. If injury to the vessels occurs, search for injury to the nearby ureters.

    Alveolar Bone Grafts

    • Plastic surgeons use iliac crest bone grafts to repair cleft palates on children, known as alveolar clefts. In a study reported in the Journal of the American Society of Plastic Surgeons on iliac bone grafting, a technique using minimally invasive surgery harvests bone graft and a device called a bone grinder is used to create the best particle size.

    Considerations

    • Certain factors can influence recovery time for patients, including smoking, long-term illnesses and age. Complications include iliac fracture and infection. Blood clots and bleeding can also occur. To avoid blood clots, patients receive assistance ambulating out of bed as soon as possible.

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