Iliac Bone Graft Donor Research Articles

Allograft-Reconstructed Iliac Bone Graft Donor Site Remodels to Viable Bone and Its Feasibility for Revision Fusion.

Bone autograft options may be limited in revision spinal fusion cases. Reconstruction of the iliac bone graft (IBG) donor site with cancellous bone allograft allows for reharvest for patients who subsequently have another fusion. This study examined viability of the reconstructed IBG (RIBG) donor sites. Secondarily, we assessed the feasibility of whether the RIBG sites could be reharvested for obtaining a successful arthrodesis for a secondary fusion. Prospectively collected data of 154 consecutive lumbar revision fusions were reviewed, of which 17 cases had their IBG donor site backfilled with allograft bone at the time of their primary fusion and subsequently had secondary surgery for a pseudarthrosis repair or fusion extension. Biopsies of the RIBG and computed tomography (CT) images were obtained at the time of secondary fusion. Histology analyzed the ratio of filled to unfilled lacunae and marrow cellularity. Histology controls were from normal iliac crest. Clinically, postoperative CT and >2-year outcomes (visual analog scale [VAS] and Oswestry Disability Index [ODI]) evaluated the feasibility of the secondary fusion surgery using RIBG. The RIBG fusion rate and outcomes were compared with clinical control revision groups that had IBG and/or bone morphogenetic protein (BMP) used for their revision fusion. CT images prior to RIBG harvest found bony healing of the original graft donor site in all except 1 case. RIBG bone marrow histology found lower cellularity vs controls, but this characteristic did not appear to compromise bone viability with filled lacunae in 83% ± 14% in the RIBG group, vs 88% ± 8% for iliac controls. After revision fusion, often combined with bone growth stimulator or BMP, repeat CT demonstrated solid spinal fusions in 16 of 17 patients, whereas control revision group fusion rates were approximately 80%. Clinical improvement was significant (VAS decrease = 3.8, ODI decrease = 16.5) and comparable with the IBG revision controls. RIBG using allograft remodels into viable predominately cancellous bone and is clinically feasible for revision fusion if IBG or BMP is unavailable. Reconstructed iliac bone graft is viable and may be used as a bone graft option.

Bridge plating with decortication, autologous bone graft, and tight closure: a "stepwise surgical diamond concept" for treatment of nonunion in a series of fifty five patients.

This study was conducted to assess a stepwise surgical procedure applied to treat a continuous series of patients with aseptic atrophic nonunion of long bones. A retrospective review was performed of the medical files of patients treated by the senior author between January 2014 and January 2021 for aseptic atrophic nonunion of long bones using a standard stepwise surgical procedure consisting of four successive surgical steps: bridge locked plating, aggressive osteoperiosteal decortication, copious autologous iliac bone grafting, and tight closure without drainage. Patients were clinically and radiographically evaluated until bone healing, then at final follow-up for the purpose of the study. The primary objective of the study was to assess completion of bone healing; secondary objectives were the time required reaching bone union, the occurrence of complications at the iliac bone graft donor site, and the achievement of bone consolidation after a second attempt of treatment when indicated following failure of the index procedure. There were a total of 55 patients. One patient died from myocardial infarction before reaching bone healing and another one lost from early follow-up. There were remaining 53 patients with 37years of mean age. The affected bone was the clavicle in five patients, humerus in 14, ulna in four, radius in one, femur in 13, and tibia in 16. The mean follow-up period was 3.4years. A total of 52 patients (98.1%) achieved bone healing at a mean of 14.8weeks from the index procedure. The only patient who did not reach bone healing after the index procedure was successfully revised using decortication-bone graft and new fixation with intra-medullary femoral nailing. Four patients (7.5%) developed local complications at the site of iliac bone harvesting. Our stepwise surgical procedure was very effective treating aseptic atrophic nonunion of long bones. However, as this study is a retrospective review of a limited series of one surgeon's experience, prospective comparative studies with large number of patients are suitable to define the advantages and indications of the procedure herein described.

278. Allograft reconstructed iliac bone graft donor site remodels to viable bone and its preliminary clinical effectiveness in revision fusion

BACKGROUND CONTEXT Bone autograft options may be limited for revision spinal fusion, particularly in long deformity cases where iliac fixation or prior IBG harvest are present. Contralateral IBG may not be available or was previously harvested. Alternatives such as bone morphogenic protein, BMP, at some facilities is not available for off-label use or due to expense. Nonviable alternatives have inconsistent ability to obtain arthrodesis in revision cases. Allograft reconstructed iliac bone graft donor site has been used to decrease donor site pain; it may also be a source of bone graft in patients with multiple prior fusions who need another fusion. PURPOSE The purpose of this study was to assess the viability of bone graft donor sites reconstructed with bone allograft. A secondary purpose of this prospective cohort study was to ascertain whether the reconstructed iliac bone graft, RIBG, sites could be reharvested for successful arthrodesis in revision fusion. STUDY DESIGN/SETTING Histologic and two cohort clinical prospective study. PATIENT SAMPLE Consecutive patients who had secondary thoracolumbar spinal fusion (pseudarthrosis repair or fusion extension) using RIBG. All these patients had their initial fusion with IBG and reconstruction of the bone graft donor site with cancellous allograft. OUTCOME MEASURES Histology of RIBG biopsies (lacunae and marrow) vs controls; clinical VAS, ODI outcomes. METHODS Revision spinal fusion patients, n=16, who had their iliac bone graft donor site backfilled with allograft bone at their initial fusion and subsequently had secondary fusion surgery for a pseudarthrosis repair or fusion extension had biopsies obtained at the time of secondary fusion. Histology analyzed the RIBG biopsies for viability and was compared to controls. One-year postop CT scans and 2+ yr outcomes measures (LBP VAS & ODI) evaluated the clinical success of the secondary fusion surgery using RIBG and compared to revision fusion controls using contralateral IBG. RESULTS Histology found filled lacunae average 83%, SD 14%, and the bone marrow was hypocellular in 2/3 of cases. Control patients had average 87%, SD; 8% and no hypocellularity. CT scans of the lumbar fusions utilizing RIBG, often combined with bone growth stimulator or bone morphogenic protein (BMP), demonstrated solid fusions in 15 of 16 patients. CT scan fusion rates of the IBG or BMP control cohorts were approximately 80%. Clinical improvement was significant (3.8 VAS decrease, p CONCLUSIONS RIBG using cancellous bone allograft remodels into viable bone autograft. This study is the first to report the histological viability of RIBG site and assess the feasibility of its use in revision fusion. RIBG may be useful in secondary fusion procedures if IBG or BMP are of limited availability. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Iliac Bone Harvesting Techniques for Bone Reconstruction. Comparative Study Between Tricortical Bone Harvesting vs Trapdoor Technique.

ObjectiveTo investigate the effects of trapdoor-procedure-based bone harvesting and tricortical iliac bone harvesting on the iliac bone-graft donor site pain experienced by patients and their clinical effects.MethodsA retrospective analysis was performed using the clinical data of 65 patients with tibial plateau fractures who received autologous iliac bone-supporting grafts in two hospitals between January 2014 and January 2019. The patients who received trapdoor-procedure-based bone harvesting (34 cases) were in the experimental group, and those who received tricortical iliac bone harvesting (31 cases) were in the control group. This study compared differences in iliac bone-graft donor site incision length, intraoperative blood loss, amount of bones harvested, operation time, and postoperative complications between the two bone-harvesting methods. Subsequently, it evaluated the pain experienced by the two patient groups in their iliac bone-graft donor sites and their clinical effects.ResultsOne week after surgery, the differences between the iliac bone-graft donor site pain score (measured using SF-MPQ-2) of the experimental group and the control group were not statistically different. However, 3 weeks, 5 weeks, and 3 months after surgery, the iliac bone-graft donor site pain scores of the experimental group were significantly lower than those of the control group. The iliac bone-graft donor site incision length and operation time of the experimental group were not significantly different from those of the control group. However, the iliac bone-graft donor site intraoperative blood loss, amount of bones harvested and the incidence of complications of the experimental group were significantly lower than those of the control group.ConclusionTrapdoor-procedure-based bone harvesting has lower donor site pain, intraoperative blood loss, and postoperative complications. However, for bone grafting in regions with significant bone loss, tricortical iliac bone harvesting remains the optimal option.

Clinically relevant complications related to posterior atlanto-axial fixation in atlanto-axial instability and their management

BackgroundThe Magerl transarticular technique and the Harms–Goel C1 lateral mass-C2 isthmic screw technique are the two most commonly used surgical procedures to achieve fusion at C1–C2 level for atlanto-axial instability. Despite recent technological advances with an increased safety, several complications may still occur, including vascular lesions, neurological injuries, pain at the harvested bone graft site, infections, and metallic device failure. MethodsWe retrospectively analyzed all patients (n=42 cases) undergoing a Harms–Goel C1–C2 fixation surgery with polyaxial C1 lateral mass screws and C2 isthmic screws at two different institutions between 2003 and 2012 and report clinical and radiological complications. One patient was lost to follow-up. The mean follow-up of the remaining 41 patients was 18.7 months (range 12–90). A clinically relevant complication was defined as a complication determining the onset of a new neurological deficit or requiring the need for a revision surgery. ResultsA total of 14 complications occurred in 10 patients (24.4% of 41 patients). Greater occipital nerve neuralgia was evident in 4 patients (9.8%). All but one completely resolved at the end of the follow-up. Persistent neck pain was reported by 3 patients (7.3%), hypoesthesia by 1 patient (2.4%), and anesthesia in the C2 area on both sides in 1 patient (2.4%). Furthermore, a superficial, a deep, and a combined superficial and deep wound infection occurred in 1 patient each (2.4%). One patient (2.4%) had pain at the iliac bone graft donor site for several weeks with spontaneous resolution. A posterior progressive intestinal herniation through the iliac scar was seen in 1 case (2.4%), which required surgical repair. No vascular damages occurred. Altogether, 5/41 patients (12.2%) had a clinically relevant complication including 4 patients necessitating a revision surgery at the C1–C2 level (9.8%). ConclusionsAtlanto-axial fixation surgery remains a challenging procedure because of the proximity of important neurovascular structures. Nevertheless, on the basis of our current experience, the C1 lateral mass-C2 isthmic screw technique appears to be safe with a low incidence of clinically relevant complications. Postoperative C2 neuralgia, as the most frequent problem, is due to surgical manipulation during preparation of the C1 screw entry point.

Continuous Bupivacaine Infusion in Iliac Bone Graft Donor Sites to Minimize Pain and Hospitalization

To assess the efficacy of continuous bupivacaine infusion at the iliac crest donor site in reducing postoperative pain and inpatient hospital stay. Forty consecutive cleft lip/palate patients who underwent alveolar bone grafting at a single institution between 2003 and 2008 were identified, and their charts were retrospectively reviewed. Opioid analgesic use, self-reported pain indices, and length of hospital stay were analyzed. Comparisons were made between those patients who received a bupivacaine infusion pump at the iliac crest harvest site and those who did not. Twenty patients underwent iliac crest bone graft harvest followed by intraoperative placement of a continuous 0.25% bupivacaine infusion pump, and 20 were managed primarily with postoperative intravenous and parenteral analgesics. There were no statistically significant differences in demographics between the two cohorts. Those patients receiving continuous bupivacaine had a decreased length of hospital stay (mean, 2.9 versus 1.4 days; p = .0077), a statistical trend toward decreased opioid use (p = .032), and a lower average subjective pain score on the day of surgery (p = .0058). There is a significant decrease in the length of hospitalization when using a continuous local infusion pump to deliver bupivacaine to the iliac crest following bone graft harvest. The pump is tolerated by patients and carries little morbidity. As such, the benefit of reduced cost from a reduced hospital stay is worthwhile. Continuous bupivacaine infusion is recommended for the iliac crest donor site.

Tacks: a new technique for craniofacial fixation.

Biodegradable fixation in craniofacial surgery provides secure fixation while eliminating much of the concern over intracranial migration of metallic plates and screws. One limitation of present biodegradable systems, however, is the need for tapping the drill hole before screw insertion. Herein, a new method of rigid, biodegradable fixation with tacks (Macrapore, Inc., San Diego, CA) is described. The tacks are made of a 70:30 ratio of the L and DL form of polylactic acid (L,DL-PLA). Degradation times range from 18 to 36 months. Newer prototypes are nearly developed for more rapid dissolution times. From April 1999 to February 2000, tack fixation has been applied in 100 patients (51 males, 49 females aged 3 months to 61 years). Indications for operation were craniosynostosis (n = 33); craniofacial trauma or post-traumatic deformities (n = 11); cleft lip and palate (n = 13); craniofacial syndromes (n = 18); other diagnoses (n = 11). Patients underwent fronto-orbital advancement with cranial reshaping; monobloc osteotomy, open reduction-internal fixation of fractures; hypertelorbitism repair; cranioplasty; stabilization of grafts; major cranial reconstruction; zygomatic advancement; alveolar cleft repair; and iliac bone graft donor site protection. Tacks were also used for temporalis muscle and lateral canthal suspension. Follow-up ranged from 16 to 28 months. Complications occurred in 7 patients, 4 of whom had infections and during debridement had biodegradable implants removed. None of the complications appeared to be related to the use of tacks. The tacks are carried in a specially designed holder and may be placed by hand or with the light tap of a mallet on the tack driver. An automatic driver has been developed. Overall, the performance of the tacks has been excellent. They are easily handled by the nursing personnel and rapidly inserted by the surgeon. Stability appears to be excellent. At this time, it is probably preferable to employ tap and screws for orthognathic surgery or other osteotomies with substantial load bearing.

Lumbar hernia: diagnosis by CT.

Lumbar hernias occur in the region of the flank bounded by the 12th rib, the iliac crest, and the erector spinae and external oblique muscles. We present the CT findings of seven lumbar hernias: six traumatic (four secondary to postoperative flank incisions, one secondary to an iliac bone-graft donor site, one secondary to nonunion of an iliac fracture) and one spontaneous. Because CT portrays the anatomic relationships in this region so well, it may be the only radiographic procedure necessary to make the diagnosis of a lumbar hernia. Furthermore, it can be helpful in the assessment of symptomatic patients after flank incision, to differentiate postincisional muscular weakness and intercostal neuralgia from a lumbar hernia.