Anterior Iliac Crest Bone Graft Research Articles

Donor Site Morbidity After Anterior Iliac Bone Graft Harvesting

Objectives: The objective of this study was to evaluate donor site morbidity associated with anterior iliac crest bone graft harvesting for orthopaedic trauma reconstructions. Design: Retrospective case series. Setting: Level 1 trauma center. Patients: Forty-Six consecutive patients who had undergone anterior iliac crest bone graft harvesting more than a 7-year period were reviewed. Intervention: Grafts were taken by removing the inner table of the ilium from 2 cm posterior to the Anterior Superior Iliac Spine. The abductor insertion was left intact and the external contour of the ilium remained unaffected. Main Outcome Measure: Visual analog scale and modified Questionnaires. Results: Thirty-seven of the 46 patients were evaluated at average follow-up of 4.5 years after anterior iliac bone graft harvesting for nonunion or fusion for posttraumatic arthrosis. No patient complained of pain at final follow-up with all patients having a visual analog scale pain of 0 at final follow-up. Three patients reported some scar numbness, however, none complained of thigh numbness. Three patients, if they needed grafting in the future would seek alternative sources based on their remembrance of significant postoperative pain. Conclusions: Anterior inner table bone graft harvesting resulted in minimal morbidity and neither pain nor functional limitations at an average of 4.5 years. This technique has lower donor-site morbidity than previous reports of posterior graft sites. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

The Evaluation of Donor Site Pain After Harvest of Tricortical Anterior Iliac Crest Bone Graft for Spinal Surgery: A Prospective Study.

A prospective cohort. The aim of this study was to prospectively observe donor site pain, health-related quality-of-life outcomes, and complications following harvest of tricortical anterior iliac crest bone graft (AICBG) for anterior cervical discectomy and fusion (ACDF). Persistent donor site pain from the anterior iliac crest has been reported to range between 2% and 40%. This morbidity has led surgeons to consider interbody alternatives for ACDF, which carry additional costs. We prospectively enrolled 50 patients from 2 tertiary care centers over the course of 1 year observing complications and patient-reported outcomes. Patients filled out SF-12 and numeric rating scale (NRS) for pain in the arm, neck, and donor site pre-operatively and at 1 week, 2 weeks, 6 weeks, 3 to 6 months, and 1 year postoperatively. Outcomes were compared with a control group undergoing ACDF with allograft or Polyether ether ketone cages at 1 year. The mean ± SD donor site pain at 1 week was 5.6 ± 2.8 but decreased to 2.2 ± 2.4 at 6 weeks and 1.1 ± 1.8 at 1 year (P < 0.001). Including the 3 patients who were lost to follow-up, 10% of patients may have experienced persistent moderate or worse pain at 1 year. Linear regression analysis demonstrated that preoperative opioid use was an independent risk factor for increased donor site pain at 1 and 2 weeks (P < 0.05). There were no differences in outcomes at 1 year compared with the nonautograft group. There were 2 (4%) minor wound complications, both treated successfully with oral antibiotics. Tricortical AICBG for ACDF is not associated with major complications and only 4% of patients (potentially, maximum of 10%) experienced moderate, persistent donor site pain at 1 year. There is no difference in health-related outcomes between patients who have autograft with those who did not at 1 year. Preoperative opioid use is associated with increased donor site pain within the first 2 weeks postoperatively but not in the long term. At 6 weeks postoperatively, patients can expect the majority of their donor site pain to be resolved. 2.

Morbidity associated with anterior iliac crest bone graft harvesting in children undergoing orthopaedic surgery: a prospective review.

PurposeAutologous iliac crest bone grafting is an integral part of many orthopaedic surgical procedures. Several studies have documented morbidity and prolonged pain following iliac crest bone graft harvesting in adults; however, in children there is a paucity of information. The purpose of the present study was to quantify the degree of pain and morbidity associated with anterior iliac crest graft harvesting in children undergoing non-spinal orthopaedic surgery.MethodsPatients were prospectively enrolled prior to orthopaedic surgery. A patient self-reported visual analogue score was used to record pain at specified time points following surgery. In addition, the patients were reviewed at 2 and 6 weeks, 3 months and 1 year after surgery to record any complications.ResultsData was collected on 33 patients (34 graft sites). Only one patient (2.94 %) had a complication, namely an injury to the lateral femoral cutaneous nerve. This resolved 3 months after surgery. 89 % of patients had no pain at the iliac crest graft harvest site 3 months after surgery. The three patients who had pain at 3 months had visual analogue scores of 1.0, 1.1 and 1.3, respectively.ConclusionThis series reveals a very low complication rate and minimal iliac crest graft harvest site pain in children undergoing non-spinal orthopaedic surgery. In addition, the pain experienced is short-lived.

Is Immediate Reconstruction of the Mandible With Nonvascularized Bone Graft Following Resection of Benign Pathology a Viable Treatment Option?

The purpose of this study was to address the following clinical question: Is immediate reconstruction of the mandible with a nonvascularized bone graft after resection of benign pathology a viable treatment option? Another purpose was to determine whether any variables affect the success of this treatment approach. The authors implemented a retrospective cohort study from a sample of patients diagnosed with a benign tumor of the mandible who were treated with segmental resection and primary reconstruction with an autogenous nonvascularized bone graft. The predictor variables were age, gender, lesion size, and diagnosis, and the outcome variable was graft success determined by re-establishment of mandibular continuity with sufficient bone for implant placement. The χ(2) test was used for statistical analysis of the categorical data and P values less than .05 were considered statistically significant. Twenty patients with benign mandibular tumors were treated with transoral resection and immediate reconstruction with nonvascularized bone grafts. The mean age was 28.3 years (range, 9 to 63 yr) and 55% (11 of 20) were men. The most common lesion type was ameloblastoma (13 of 20) and all patients underwent reconstruction with autogenous anterior iliac crest bone grafting. Ninety percent of patients (18 of 20) had successful reconstruction. Ten patients underwent successful implant placement and restoration. Using careful patient selection, treatment of benign pathology with transoral resection and immediate reconstruction with a nonvascularized bone graft from the anterior iliac crest can be successful. In addition, the total treatment time from implant restoration to return to preoperative function is minimized. Therefore, this method of treatment is a viable treatment option and an alternative to delayed reconstruction or reconstruction with vascularized bone flaps.

The Reamer–Irrigator–Aspirator as a Device for Harvesting Bone Graft Compared With Iliac Crest Bone Graft

This study was performed to compare patient outcomes after Reamer-Irrigator-Aspirator (RIA)-harvested bone grafting with the current gold standard, either anterior or posterior iliac crest bone graft (ICBG). Prospective randomized controlled trial. Multicenter study at 3 geographically separate Level 1 trauma centers. One hundred thirty-three patients with nonunion or posttraumatic segmental bone defect requiring operative intervention. Patients were prospectively randomized to receive ICBG or RIA autograft. Supplemental internal fixation was performed per surgeon preference. Operative data included amount of graft, time of harvest, and associated surgical costs. The Short Musculoskeletal Functional Assessment and the Visual Analog Scale were used to document baseline and postoperative function and pain. Clinical and radiographic union was the defined end point; patients considered to have failed treatment if they either developed an infection requiring operative treatment or had a persistent nonunion of the grafted extremity. One hundred thirteen of the 133 enrolled patients were followed until union and included in the final analysis. Intraoperative data showed anterior ICBG to yield 20.7 ± 12.8 (5-60) cm of autograft with an average harvest time of 33.2 ± 16.2 minutes, posterior ICBG yielded 36.1 ± 21.3 (20-100) cm of autograft in 40.6 ± 11.2 minutes, and RIA yielded 37.7 ± 12.9 (5-90) cm in 29.4 ± 15.1 minutes. Anterior ICBG produced significantly less bone graft than either RIA or posterior ICBG (P < 0.001). The RIA harvest was completed in significantly less operative time compared with posterior ICBG (P = 0.005). At $738, the RIA setup was considerably more expensive than the ∼$100 cost of a bone graft tray; however, when compared with posterior ICBG, the longer operative time required for a posterior harvest came at an additional incremental cost of $990-1880, making RIA the less expensive option. Patients were followed for an average of 56.9 ± 42.1 (11-250) weeks. Forty-nine of 57 patients (86.0%) who received ICBG united in an average of 22.5 ± 13.2 weeks; 46 of 56 patients (82.1%) who received RIA healed in an average of 25.8 ± 17.0 weeks. Union rates and time to union were comparable between the 2 procedures. There was no difference in complications requiring reoperation for persistent nonunion or infection at the grafted site, nor there was any difference in donor-site complications. Postoperative follow-up showed that RIA patients had significantly lower donor-site pain scores throughout follow-up. When compared with autograft obtained from the iliac crest, autograft harvested using the RIA technique achieves similar union rates with significantly less donor-site pain. RIA also yields a greater volume of graft compared with anterior ICBG and has a shorter harvest time compared with posterior ICBG. For larger volume harvests, cost analysis favors using RIA. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Comparison of efficacy of mandible and iliac bone as autogenous bone graft for orbital floor reconstruction.

This study evaluated and compared the efficacy of mandible and iliac bone as autogenous bone graft for correction of orbital floor fractures. Twenty patients who suffered orbital floor fractures took part in the study. The subjects enrolled in the study sustained both isolated orbital floor fracture and orbital floor fracture associated with fracture of zygomatico-maxillary complex. Each inferior orbital wall was reconstructed using either a mandible bone graft or an iliac graft. Mandibular symphysis was opted as a donor site for graft harvest from mandible and anterior iliac crest for the iliac group. CT scans were taken before the operation. Inclusion criteria consisted of at least 2months postsurgical follow-up, pre- and post-surgical photographic documentation, and complete medical records regarding inpatient and outpatient data. To describe the distribution of complications and facilitate statistical analysis, we categorized our findings into diplopia, enophthalmos, and restriction of ocular movements before and after treatment. We also considered the time required for the harvest of the grafts and the donor site complications. A comparative study was carried out using Chi square test and student t test. We considered P value <0.05 to be statistically significant. Ten iliac crest grafts and ten mandible bone grafts were placed. The mean age of the patients was 33.1years. 80% of the patients were males. The most common complication of orbital floor fracture was diplopia, followed by enophthalmos and restriction of ocular movements. The post operative results were compared after 2months of the surgery. In iliac crest group, diplopia got corrected in six out of seven patients (85%), enophthalmos in four out of five patients (80%) and restricted ocular movement showed 100% correction. While in mandible group, diplopia and ocular movement showed 100% correction and enophthalmos got corrected in five out of six patients (83%). No statistically significant differences were found between the two groups on comparing these variables. On the other hand the mean time required for the harvest of iliac graft and mandible graft was 30.2±3.52min and 16.8±1.75min respectively. The difference was statistically significant. There is no difference in the ability of mandible and anterior iliac crest bone grafts to correct post-traumatic diplopia, enophthalmos and restricted ocular movements. But the time and ease of harvest of the graft from mandible was comparatively less and easy especially when the treating doctor was an oral and maxillofacial surgeon. Secondly the post-operative morbidity was low and the quality and contour of the bone graft was very adaptable for the reconstruction of the orbital floor.

Normal anatomy and variations of the lateral femoral cutaneous nerve in relation to the iliac crest: implications for anterior iliac crest bone grafts (726.10)

Anterior iliac crest bone grafting (AICBG) remains the gold standard for reconstructive procedures in orthopedic and oral‐maxillofacial surgeries. It has been estimated that 10% of patients undergoing AICBG are at risk of injury to their lateral femoral cutaneous nerve (LFCN). Injury to this nerve can result in numbness, burning, itching or pain sensations over the lateral aspect of the thigh, known as meralgia paresthetica. The course of the LFCN within the greater pelvis cannot be seen with imaging technologies. The objective of this study is to elucidate the 3D course and variability of the LFCN as it emerges from the psoas major muscle to the anterior superior iliac spine (ASIS). Using 25 embalmed cadavers, the length and depth of the LFCN is measured from the ASIS to 7 cm posterior to the ASIS at 1 cm intervals. Preliminary results (n=10 sides) show these measurements are highly variable between cadavers and that there are three ways the nerve courses: convex, concave or straight course. The first three dimensional danger‐zone of the LFCN relative to the iliac crest will be established and incorporated onto a 3D illustration of the pelvic bone using Amira software. A predictive model will be determined to approximate the location of the LFCN with respect to age, sex, height, bone width, and ASIS‐ASIS distance. A better understanding of the course of the LFCN is important to minimize graft site morbidity.

Naso Alveolar Cleft Reconstruction: Does Patients’ Age Play a Factor in Postoperative Complication Rate?

Purpose: The purpose of this report is to compare the outcome of unilateral alveolar cleft reconstruction (ACR) in patients aged 6 - 8 years versus older more comprehending patients aged 9 - 12 years. Materials and Methods: A chart review (from March 2006 to June 2010) was conducted of patients who had alveolar cleft reconstruction using anterior iliac crest bone graft. All the cases included are non syndromic healthy patients whom had unilateral alveolar cleft and were operated for the first time. A total of 49 healthy patients were included in the study. Twenty-four had their surgery between the age of 6 and 8 (Group A), and twenty-five had theirs between 9 and 12 (Group B). The postoperative recovery and complications were compared between the two groups. Results: In group A, 16% (n = 4) showed minimal wound dehiscence while 8% (n = 2) had a minor wound infection due to food particles wedged in the wound. In Group B, 20% (n = 5) of the patients presented with minimal wound dehiscence, while 12% (n = 3) had minor wound infection due to food particles wedged in the wound. No significant difference was found between the two groups using Fisher’s exact test, two-tailed p-value >0.05. Conclusion: Age factor was not found to be a factor contributing to ACR complication rate.

Prospective Observational Study of Donor-Site Morbidity Following Anterior Iliac Crest Bone-Grafting in Orthopaedic Trauma Reconstruction Patients

Complications associated with iliac crest bone-graft donor sites have been reported. This prospective study was conducted to determine the prevalence of pain and complications at the iliac crest donor site in patients undergoing treatment of fracture nonunion. Ninety-two patients undergoing anterior iliac crest bone-grafting for nonunion or delayed union of a long-bone fracture were prospectively enrolled. Twenty-seven patients undergoing an alternative surgical treatment were enrolled as a control group. Questionnaires including pain on a visual analog scale (0 to 10) at the donor site were completed by patients at two weeks, six weeks, three months, and one year postoperatively. Short Form-36 (SF-36) forms were completed at enrollment and at the time of final follow-up. The mean pain on the visual analog scale at the donor site was 3.9 at two weeks but rapidly decreased to 1.4 at six weeks and reached 0.3 at one year or more postoperatively (p<0.001). Only two patients (2%) reported a pain value of >3 at one year or more postoperatively. There were three deep infections (3%) at the donor site, and no patients had a permanent sensory deficit in the lateral femoral cutaneous nerve distribution. At the time of final follow-up (mean, twenty-two months), scores for the SF-36 bodily pain subscale were significantly higher in the iliac crest group than in the control group, indicating a greater improvement in overall bodily pain in the iliac crest group. Anterior iliac crest bone-grafting for nonunion was a well-tolerated procedure. Substantial, persistent pain at the iliac crest donor site occurred in 2% of patients. Iliac crest bone-grafting did not appear to impair function or well-being compared with alternative treatments.

Continuous Infusion of Bupivacaine for Pain Control after Anterior Iliac Crest Bone Grafting for Alveolar Cleft Repair in Children

The purpose of this study was (1) to evaluate the analgesic efficacy of continuous infusion bupivacaine, (2) to evaluate the effects of the site-specific catheter infusion on operating room time, narcotic use, ambulatory status, and length of hospitalization, (3) to monitor for adverse outcomes, and (4) to assess patient/family acceptance. Randomized, double-blinded, and prospective study of bupivacaine versus saline for pain control after anterior iliac crest bone grafting for alveolar cleft repair. University of Alabama at Birmingham. A total of 65 pediatric patients with alveolar cleft defects treated between 2006 and 2009. Anterior iliac crest bone grafting for alveolar cleft repair with assignment to either a bupivacaine or a saline infusion group. Physical examination, pain ratings, narcotic use, ambulatory status, operating room time, and length of hospital stay. On the blinded physical exam, 71% in the bupivacaine infusion group and 42% in the saline infusion group were assessed as not experiencing pain at the surgical hip site. The experimental group used less narcotics compared with the control group. No significant differences were noted with operating room time, initial ambulatory status, or length of hospitalization (1.09 versus 1.12 days). Satisfaction and acceptance of the catheter treatment was universal. These results suggest that postoperative infusion of bupivacaine may be efficacious for enhancing pain relief after bone harvest in pediatric patients and may enhance parental perceptions of postoperative care; however, this patient population is difficult to study accurately.

Ultrasound-guided transversalis fascia plane block provides analgesia for anterior iliac crest bone graft harvesting

To the Editor, The iliac crest is primarily innervated by the L1 nerve root via the iliohypogastric and ilioinguinal nerves. We describe our preliminary experience with a transversalis fascia plane (TFP) block, which targets these nerves in the plane between the transversus abdominis (TA) aponeurosis or muscle and the deeper transversalis fascia. It can thus provide effective analgesia for anterior iliac crest bone graft (ICBG) harvesting. This technique is distinct from the transversus abdominis plane block, which does not reliably block the L1 dermatome, although its use has been described in ICBG harvesting. Following Ethics Board approval, we reviewed the records of 27 adult patients who underwent harvesting of an anterior ICBG as part of surgery on the distal forearm and wrist between November 1, 2009 and February 28, 2011 at the Toronto Western Hospital. All patients underwent general anesthesia preceded by a single-shot brachial plexus block with 30–40 mL of local anesthetic (1:1 mixture of 2% lidocaine and 0.5% bupivacaine, with epinephrine 2.5 lg mL). Twelve (44%) patients also underwent an ultrasound-guided TFP block. The ultrasound probe was placed in a transverse orientation above the iliac crest; and the external oblique, internal oblique (IO), and TA muscles were identified and traced posteriorly until first the TA muscle and then the IO muscle tapered into their common aponeurosis, adjacent to the quadratus lumborum muscle (Figure, A). The tip of a 22-gauge 80-mm block needle was positioned just deep to the TA muscle and its aponeurosis at the point where the TA tapered off. Ropivacaine 0.5% (20 mL) with epinephrine 5 lg mL was injected into the plane between the TA and underlying transversalis fascia (Figure, B). Intraoperative and postoperative analgesia of the ICBG harvest site was provided by systemic opioids at the discretion of the operating theatre and postanesthesia care unit (PACU) staff. We extracted data on opioid consumption and pain scores during the immediate perioperative period, defined as the time at which the patient entered the operating room to the time the patient left the PACU. We converted all opioid doses into intravenous morphine equivalents and divided patients into two groups for comparison based on whether they had undergone a TFP block. The mean (standard deviation) perioperative opioid dose was substantially lower in the patients who underwent a TFP block [18.5 (9.6) mg of intravenous morphine equivalent] than in those who did not [32.6 (12.4) mg] (P = 0.006). These patients received less intravenous morphine during both the intraoperative period [10.2 (5.6) mg vs 17.4 (6.6) mg; P = 0.009] and the PACU period [8.3 (9.6) mg vs 15.1 (11.2) mg; P = 0.114]. It is of note that only one (8%) patient received intravenous ketorolac 30 mg in the TFP group compared with five (33%) patients in the other group. Patients who underwent a TFP block also had lower resting pain scores in the PACU. Pain scores (median [range]) were lower in the TFP group both at admission to the PACU (2 [0–6] vs 6 [5–7]; P = 0.015) as K. J. Chin, MBBS (&) V. Chan, MD M. Harris, MB BChir Toronto Western Hospital, University of Toronto, Toronto, ON, Canada

Anterior Versus Posterior Approach to Iliac Crest for Alveolar Cleft Bone Grafting

The goal of this study was to compare perioperative outcomes for the anterior versus posterior approach to the iliac crest for alveolar bone grafting in patients with cleft lip and palate (CLP). A retrospective cohort study of patients with CLP who had an anterior or posterior iliac crest bone graft during a 10-year period was performed. Available medical records were reviewed and the outcome variables documented included the operation site for bone graft procurement (anterior or posterior), estimated blood loss, duration of operation, concurrent procedures, and length of hospital stay. The 2 groups were compared by t test, Fisher exact test, and multivariate regression to show differences. There were 239 patients with CLP who had an iliac crest bone graft to the alveolar cleft; 133 had an anterior and 106 a posterior approach for bone graft procurement. The mean estimated blood loss was significantly less with the posterior approach (85 vs 177 mL; P < .0001). The mean operation duration with the posterior approach was longer (4.6 vs 3.5 hours; P < .0001). Most patients in this group (67%), however, had 2 or more additional procedures during the same anesthetic, whereas only 16% of patients in the anterior group had 2 or more additional procedures. The mean length of stay was significantly shorter for the posterior approach (1.7 vs 2.2 days; P < .0001). These results suggest that patients having a bone graft from the posterior iliac crest have a smaller estimated blood loss and a shorter length of stay. In addition, this approach permits repair of the alveolar cleft and additional procedures, including augmentation of the median tubercle and correction of nasolabial distortions, which are often present in patients with CLP.

Local Administration of Morphine for Analgesia After Autogenous Anterior or Posterior Iliac Crest Bone Graft Harvest for Spinal Fusion

Wai, Eugene K.*†; Sathiaseelan, Seyon*; O'Neil, Joseph O.*†; Simichison, Brian L.‡ Author Information

Two level cervical corpectomy with iliac crest fusion and rigid plate fixation: a retrospective study with a three-year follow-up.

There is no clear knowlegde in the literature about two-level vertebral corpectomy using the iliac bone crest for fusion and rigid plate fixation. We present our experience with two-vertebral level cervical corpectomy and reconstruction.Each patient was graded according to the Nuricks Grade (1972) and the modified Japanese Orthopaedic Association (mJOA) Scale (1991), and the recovery rates were calculated. All patients had two-level vertabral corpectomy. Anterior iliac crest bone graft with titanium plate fixation was applied to all patients.Postoperatively the mJOA score raised up to 15.5. Mean recovery rate was 69%. Average 25.2 degrees correction of kyphosis was achieved in 21 patients. Among the postoperative complications, three cases (12%) had temporary C5 nerve palsy that was resolved in three weeks, two cases had (8 %) graft malposition and infection, and three cases (%12) had temporary donor site pain.Excellent fusion rates can be achieved following two-level corpectomy with iliac bone graft repacement. This techique is easy, cost effective and safe. If the bone graft is harvested from the iliac crest by standart approach and between anatomical landmarks, most patients do not experience persistent pain at the donor site.

Two level cervical corpectomy with iliac crest fusion and rigid plate fixation: a retrospective study with a three-year follow-up.

There is no clear knowlegde in the literature about two-level vertebral corpectomy using the iliac bone crest for fusion and rigid plate fixation. We present our experience with two-vertebral level cervical corpectomy and reconstruction. Each patient was graded according to the Nuricks Grade (1972) and the modified Japanese Orthopaedic Association (mJOA) Scale (1991), and the recovery rates were calculated. All patients had two-level vertabral corpectomy. Anterior iliac crest bone graft with titanium plate fixation was applied to all patients. Postoperatively the mJOA score raised up to 15.5. Mean recovery rate was 69%. Average 25.2 degrees correction of kyphosis was achieved in 21 patients. Among the postoperative complications, three cases (12%) had temporary C5 nerve palsy that was resolved in three weeks, two cases had (8 %) graft malposition and infection, and three cases (%12) had temporary donor site pain. Excellent fusion rates can be achieved following two-level corpectomy with iliac bone graft repacement. This techique is easy, cost effective and safe. If the bone graft is harvested from the iliac crest by standart approach and between anatomical landmarks, most patients do not experience persistent pain at the donor site.

The Ultrasound-Guided Transversus Abdominis Plane Block for Anterior Iliac Crest Bone Graft Postoperative Pain Relief

Acute postoperative pain and nerve injuries frequently lead to neuropathic chronic pain after anterior iliac crest (AIC) bone graft. This prospective study evaluated postoperative pain relief after preoperative ultrasound-guided transversus abdominis plane (TAP) block for orthopedic surgery with an AIC bone harvest and the prevalence of pain chronicization at 18 months after surgery. Thirty-three consecutive patients scheduled for major orthopedic surgery with an AIC harvest for autologous bone graft were studied. Preoperative TAP blocks were performed under in-plane needle ultrasound guidance, anterior to the midaxillary line (15 mL ropivacaine 0.33%). The extent of sensory blockade was evaluated at 20 mins with cold and light-touch tests. Pain at the iliac crest graft site was assessed at rest by visual analog scale (VAS) scores in the postanesthetic care unit, and at 1, 6, 12, 24, and 48 hrs after surgery. Time for first request of morphine and total morphine consumption were recorded. Eighteen months after surgery, each patient was interviewed by phone about the importance and localization of pain chronicization. Median VAS score was 0 (range, 0-7) at all periods of assessment. At 20 mins, 62.5% of the patients reported complete anesthesia, and 34% hypoesthesia. The sensory blockade extent ranged from T9 (T7-T11) to L1 (T11-L2) in median (range) values. At 18 months, 80% of patients did not complain about pain or discomfort at the iliac crest site; 20% reported pain chronicization at the iliac crest site (VAS scores 2-4). Five patients (26%) complained about numbness at the iliac crest area. Ultrasound-guided TAP block is an appropriate technique for postoperative analgesia after AIC bone harvest in orthopedic surgery.

The anatomical variation of the lateral femoral cutaneous nerve in relation to the anterior superior iliac spine and the iliac crest

The location of lateral femoral cutaneous nerve (LFCN) in relation to the anterior superior iliac spine (ASIS) and the iliac crest was investigated in 96 embalmed cadaveric specimens. Fifty-six nerves (58.3%) passed medial to the ASIS. Twenty-two nerves (22.9%) passed at the ASIS. Eighteen nerves (18.8%) passed lateral to the ASIS. The LFCN is usually located at 2.1 +/- 0.8 to 3.9 +/- 1.0 cm below the crest in the range of 2-5 cm lateral to the ASIS, respectively. When the anterior iliac crest bone graft harvesting is planned, the anatomical variation in this area should be concerned to reduce the risk of LFCN injury.

Local Administration of Morphine for Analgesia After Autogenous Anterior or Posterior Iliac Crest Bone Graft Harvest for Spinal Fusion: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study

Harvesting of iliac crest graft for spinal fusions is associated with a number of patients reporting residual or chronic pain at the harvest site. Various interventions, including morphine infiltration, have been proposed to minimize the associated pain. We performed a prospective, double-blind, randomized, placebo-controlled study comparing intraoperative infiltration of 5 mg morphine (treatment) versus saline (placebo) into the iliac crest harvest site for patients undergoing elective spinal surgery. Patients with myelopathy, excessive perioperative opioid use (60 mg equivalent morphine/d or more), or multilevel (>3 levels) spinal surgery were excluded. Postoperative administration of morphine (recovery room and patient-controlled analgesia) was standardized. Numerical pain scores specific for the iliac crest site were determined in the immediate postoperative period and at 3, 6, and 12 months. Of the 54 patients randomized, 47 (87%) were available for review with a minimum of 1-year follow-up. The groups were similar in baseline age, gender, and comorbidities. There was no significant difference between groups in total use of postoperative morphine during the first 24 hours (P = 0.48). Repeated measures analysis of variance demonstrated no interacting effect of group over time for hip pain at rest (P = 0.94), hip pain while moving (P = 0.90), spine pain at rest (P = 0.99), or spine pain while moving (P = 0.83). The proportion of patients reporting iliac crest pain at 1-year follow-up was the same between groups (P = 0.95). This study has demonstrated that there are no additional benefits for the use of intraoperative infiltration of morphine into the iliac crest harvest site during spinal fusions.

Iliac screw combined with pedicle screw system internal fixation and one-stage anterior focus elimination plus bone grafting in the lumbosacrai tuberculosis

Objective To study the method and therapeutic efficacy of the combined iliac screw with pedicle screw system internal fixation and one-stage anterior interbody autograft with iliac crest bone after focal cleaning in lumbosacral tuberculosis. Methods We summarized our 12 cases with lumbosacral tuberculosis treated using iliac screw combined with pedicle screw system internal fixation and one-stage anterior focus elimination plus iliac crest bone grafting during 3 years. Results All the incisions were healed by first intention. All patients can off-bed activity wearing lower back protector two weeks after operation and above eight months after operation,the follow up X-ray film showed all bone-grafts obtained solid fusion. Conclusion It was a safe and reliable method to treat lumbosacral tu-berculosis by using ilisc screw combined with pedicle screw system internal fixation and one-stage anterior focus elimi-nation plus iliac crest bone grafting. Key words: Tuberculosis, spinal; Bone transplantation; Internal fixators

Poster 01: Continuous Infusion of Bupivacaine for Pain Relief After Anterior Iliac Crest Bone Grafting for Alveolar Cleft Repair and Its Applications

Poster 01: Continuous Infusion of Bupivacaine for Pain Relief After Anterior Iliac Crest Bone Grafting for Alveolar Cleft Repair and Its Applications