Iliac Crest Donor Site Research Articles

Retrospective evaluation of postoperative analgesia efficacy of a new technique in anterior iliac crest bone graft harvesting: anterior iliac block

BackgroundIn reconstructive surgeries, iliac crest bone graft harvesting is commonly preferred. The pain experienced after surgery at the anterior iliac crest (AIC) donor site might be more intense compared to the pain at the primary surgical area where the graft is placed. To address this issue, we defined a novel technique called the anterior iliac block (AIB), which can provide analgesia with lower volumes. In this study, the effect of this technique for AIC bone greft harvesting was evaluated.MethodsPatients who were operated on and had AIC bone graft harvested included in this retrospective study. The study collected age, height, weight, ASA classification, and duration of surgery, information on the regional anesthesia technique, block performance, postoperative pain severity, opioid consumption, rescue analgesics used in the first postoperative 24 h.ResultsData from 16 patients were analyzed. The popliteal sciatic block was performed in eight patients, infraclavicular brachial plexus block in four patients, supraclavicular brachial plexus block in one patient, PENG block in one patient, and proximal adductor canal block in two patients two provide analgesia for primary surgery. The median morphine consumption at postoperative 24th hour was 3.5 mg, median NRS score was 1 at postoperative 1st hour, and 0 at postoperative 6th, 12th and 24th hours.ConclusionsThe study findings indicate that the AIB provides adequate analgesia for AIC graft harvesting in the first postoperative 24-hour period. It can be used as an adjuvant to the peripheric nerve block for the primary surgical site.Trial registrationNCT06295224.

Implications of the composite free flap harvest site on quality of life after head and neck surgery: a prospective series

Quality of life (QOL) has become a primary determinant of the treatment outcome. There is a poor evidence base regarding the QOL implications of free flap harvest from the various different osseous composite donor sites. This prospective study assessed the impact of free flap harvest on QOL and compared QOL morbidity between fibula, scapula, and iliac crest (deep circumflex iliac artery; DCIA) donor sites in head and neck reconstructive surgery. This was a single-site prospective cohort clinical research study. Fifty-nine patients were recruited between 2017 and 2021; 30 underwent fibula flap reconstructive surgery, 17 scapula flap, and 12 DCIA flap. The patients were assessed using the University of Washington Quality of Life Questionnaire version 4 (UW-QOL v4) preoperatively and again at >12 months postoperatively. The results showed no significant change in the mean global QOL score postoperatively when compared to the preoperative baseline in any of the donor site groups. However, the mean postoperative scores for the appearance domain were significantly lower than the preoperative scores in all of the donor site groups. In addition, fibula flap patients had significantly reduced physical activity and recreation QOL domain scores postoperatively when compared to the preoperative scores.

A Novel Technique for Tarsal Metatarsal Joint (TMTJ) Fusion using Calcaneal Precision Bone Graft: Reducing Morbidity Associated with Bone Graft Donor Site

Category: Midfoot/Forefoot; Basic Sciences/Biologics; Other Introduction/Purpose: TMTJ fusion has long been used as a treatment for TMTJ disease. Bone grafting has been shown to potentially improve union rates and often the iliac crest as a donor site has been used to achieve this. Indications for bone grafting include severe disease with greater bone loss and deformity, multiple joints being fused or revision surgery. In our paper we report on our experience of TMTJ fusion using localised bone grafting from either the calcaneum or cuneiform. This incorporates a novel operative technique for graft placement which increases contact area for healing and restores foot biomechanics. This may also therefore reduce non-union rate. Additionally, this localised form of bone grafting avoids the morbidity associated with iliac crest donor sites providing a better tolerated procedure. Methods: Twenty patients were included between 2016 and 2019 who underwent fusion of 39 TMTJs in total. Of these 39 joints 9 were first, 16 were second and 14 were third TMTJ. Two of the first TMTJ Fusions were revisions with double plating and bone grafting for non union. Fourteen patients had standard bone grafting and donor sites were as follows; 7 calcaneal, 1 cuneiform, 6 iliac crest. Seven patients had excision of OA joint and bone graft using precision instruments and surgery using our described technique. Locking plates were used in all twenty patients. Post-operative care included a wound check at two weeks, non-weight- bearing in a cast for 6 weeks and then weight-bearing cast for a further 6 weeks. Patients were followed up in clinic to observe radiological and clinical union. Ct scanning employed when delayed union was suspected. Complications with wound healing and infection were also recorded. Results: 15 of patients were female with a mean age of 59. 38 out of 39 fused joints went on to unite. 10 patients were initially assessed in the Specialist Limb Service (SLS) clinic with gait analysis prior to surgery. One non-union was diagnosed on CT scan in the traditional bone graft technique group. Graft was harvested from iliac crest in this case. All other graft sites resulted in fusion of the joint. All seven patients (100%) who had excision and bone graft using precision bone instruments with the new technique had union without delay. One patient underwent removal of metalware due to prominence. This was a revision double plating case. There were no wound healing problems and no postoperative infections. 80% of patients were satisfied with the results of surgery and reported improvement in quality of life. Conclusion: TMTJ fusion with looking plates remains an appropriate treatment for TMTJ disease providing high rates of successful union. Local donor site for bone grafting does not generate inferior outcomes whilst avoiding the morbidity associated with iliac crest harvesting. Additionally, this work presents a novel technique using precision bone graft instruments and cylindrical bone graft to fuse the TMTJ in the presence of OA. This technique generates increased fusion surface area and may provide better restoration of normal foot biomechanics.

Addition of Bone Marrow Aspirate Concentrate Resulted in High Rate of Healing and Good Functional Outcomes in the Treatment of Clavicle Fracture Nonunion: A Retrospective Case Series.

Bone marrow aspirate concentrate (BMAC) is an autologous cell composition that is obtained through a needle aspiration from the iliac crest. The purpose of this study was to evaluate the outcomes of patients treated with open reduction and internal fixation with BMAC supplementation for clavicle fracture nonunion. This was a retrospective case series of 21 consecutive patients with clavicle fracture nonunion that were treated with ORIF and BMAC supplementation between 2013 and 2020. Patients were evaluated for fracture union, time to union, complications related to surgical and donor site, and functional outcome using the Quick Disability of the Arm Shoulder and Hand (QDASH), subjective shoulder value (SSV), and pain. The mean age was 41.8 years. The mean follow-up was 36 months. Twenty (95.2%) patients demonstrated fracture union, with a mean time to union of 4.5 months. Good functional scores were achieved: SSV, 74.3; QDASH, 23.3; pain level, 3.1. There were no complications or pain related to the iliac crest donor site. Supplementary BMAC to ORIF in the treatment of clavicle fracture nonunion is a safe method, resulting in high rates of fracture union and good functional outcomes with minimal complications and pain.

Open Reduction and Internal Fixation for Humeral Shaft Nonunion: Bone Grafting Is Not Routinely Required and Avoids Donor Site Morbidity.

To document union rate, complications and patient-reported outcomes after open reduction and internal fixation (ORIF), with and without bone grafting (BG), for humeral diaphyseal nonunion after failed nonoperative management. Retrospective. University teaching hospital. From 2008 to 2017, 86 consecutive patients [mean age 59 years (range 17-86), 71% (n = 61/86) women] underwent nonunion ORIF (plate and screws) at a mean of 7 months postinjury (range 3-21.5). Eleven (13%) underwent supplementary BG. Union rate and complications for 83 patients (97%) at a mean of 10 months (3-61). Patient-reported outcomes (QuickDASH, EQ-5D, EQ-VAS, SF-12, satisfaction) for 53 living, cognitively-intact patients (78%) at a mean of 4.9 years (0.3-9.2). Ninety-three percent (n = 77/83) achieved union after nonunion ORIF. Complications included recalcitrant nonunion (7%, n = 6/83), iatrogenic radial nerve palsy (6%, n = 5/83), infection (superficial 7%, n = 6/83; deep 2%, n = 2/83), and iliac crest donor site morbidity (38%, n = 3/8). The union rate with BG was 78% (n = 7/9) and without was 95% (n = 70/74; P = 0.125), and was not associated with the nonunion type (atrophic 91%, n = 53/58; hypertrophic 96%, n = 24/25; P = 0.663). Median QuickDASH was 22.7 (0-95), EQ-5D 0.710 (-0.181-1), EQ-visual analog scale 80 (10-100), SF-12 physical component summary 41.9 (16-60.5), and mental component summary 52.6 (18.7-67.7). Nineteen percent (n = 10/53) were dissatisfied with their outcome. ORIF for humeral diaphyseal nonunion was associated with a high rate of union. Routine BG was not required and avoided the risk of donor site morbidity. One in 5 patients were dissatisfied despite the majority achieving union. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Autogenous iliac crest bone grafting for tibial nonunions revisited: does approach matter?

Tibial nonunion remains a considerable burden for patients and the surgeons who treat them. In recent years, alternatives to autogenous grafts for the treatment of tibial nonunions have been sought. The purpose of this study was to evaluate the efficacy of autogenous iliac crest bone graft (ICBG) in the treatment of tibial shaft nonunions. Sixty-nine patients were identified who underwent ICBG for repair of atrophic or oligotrophic tibial nonunion and had complete data with at least one year of follow-up (mean 27.9months). Surgical treatments consisted of revision/supplemental fixation ± ICBG. Surgical approaches for graft placement were either posterolateral (PL), anterolateral (AL), or direct medial (DM). Healing status, time to union, postoperative pain, and functional outcomes were assessed. Bony union was achieved by 97.1% (67/69) of patients at a mean time of 7.8 ± 3.2months postoperatively. There was no significant difference in mean time to union between the three surgical approach groups: (PL (44.9%) = 7.3months, AL (20.3%) = 9.2months, DM (34.8%) = 7.6months; p = 0.22). Intraoperative cultures obtained at the time of nonunion surgery were positive in 27.5% of patients (19/69). Positive cultures were associated with need for secondary surgery as 8/19 patients (42.1%) with positive cultures required re-operation. Two out of four patients that developed iliac donor site hematomas/infections requiring washout had positive intraoperative cultures as well. There was no difference in final SMFA among the three surgical approach groups. Autogenous ICBG remains the gold standard in the management of persistent tibial nonunions regardless of surgical approach. There is a small risk for complication at the iliac crest donor site. Given the high union rate, autogenous iliac crest bone grafting for tibial nonunion remains the gold standard for this difficult condition. Level III.

The Effect of Single-Dose Bupivacaine on Postoperative Iliac Crest Graft Donor Site Pain.

Background:Postoperative donor site pain remains a major source of morbidity following iliac crest bone graft harvesting (ICBGH).Aim:The aim of this study was to investigate the effect of single-dose infiltration of bupivacaine on donor site pain following ICBGH.Subjects and Methods:This study was a double-blind randomized controlled trial of 30 adult individuals that required an ICBG as part of the treatment for mandibular reconstruction. Individuals were divided into two groups, to receive a single-dose subcutaneous infiltration of either 0.25% bupivacaine or 0.9% normal saline at the iliac crest graft incision site following ICBGH. Length of incision at the ICBGH site, dimensions of harvested graft, time taken for the iliac crest harvest surgery, total daily dose of postoperative analgesics, pain from the ICBGH site as well as gait disturbance were recorded. Data were analyzed using SPSS version 17.0, and P < 0.05 was considered statistically significant.Results:There was a progressive decrease in pain score from the 1st to the 4th postoperative day, with no significant difference between the two groups. There was no statistical difference between the two groups in terms of dynamic median pain score at the early postoperative period as well as at the 4th and 12th week postoperative period. The analgesic consumption between the two groups also did not show any significant difference.Conclusion:Local injection of single dose of 0.25% bupivacaine did not offer additional benefit in the management of postoperative iliac crest donor site pain following ICBGH.

Optimizing donor site analgesia after bone harvest from iliac crest

At Queens Medical Centre, Nottingham, alveolar bone grafts (ABG) for patients with cleft lip and palate (CLP) were performed by two surgeons following the same surgical protocol, but with different postoperative iliac crest donor site analgesia: surgeon A used a donor site bolus of levobupivacaine, whilst surgeon B used a donor site epidural catheter (EC) infusing levobupivacaine. A healthcare evaluation was conducted in two phases to establish the effectiveness of analgesia for CLP patients undergoing ABGs. Data were collected prospectively in 2016 and 2018. Cleft patients postoperative to ABG were included. Outcome measures were pain scores at 2, 4, 6, 12, and 24 hours, time to mobilization, and time to food intake. Mean pain scores at the first evaluation were <1 out of 10 for all time points, except 24 hours (score 2.0 for bolus, 1.8 for EC). There was no statistically significant difference between the groups for any of the outcomes measured. As EC conferred no advantage, surgeon B changed to bolus administration and a second evaluation was performed. The mean pain score for the second evaluation was 1.7 and higher pain scores were more common with lower doses of levobupivacaine. The data suggest that bolus injection can produce safe, effective pain control provided an adequate dose is given.

Patients Cannot Reliably Distinguish the Iliac Crest Bone Graft Donor Site From the Contralateral Side After Lumbar Spine Fusion: A Patient-blinded Randomized Controlled Trial.

A multicenter, randomized, intrapatient controlled trial. This study investigated whether lumbar fusion patients blinded to the harvest site (A) can identify the iliac crest used for bone harvesting and (B) whether this iliac crest is more painful than the contralateral side. Spinal fusion with iliac crest autograft is a frequently performed surgical procedure. A widely reported disadvantage of the harvesting procedure is potential donor site morbidity. This has driven the development of many bone graft substitutes. However, more recently the incidence and severity of donor site pain is debated, especially in lumbar fusion surgery. Ninety-two nontraumatic adult patients underwent a posterolateral (thoraco)lumbar fusion. Iliac crest bone graft was harvested unilaterally through the primary midline incision. At 6 weeks, 3 months, 6 months, and 1 year follow-up, patients were asked to identify the donor site and to rate pain in their back, left iliac crest and right iliac crest on a Visual Analogue Scale (VAS). Ninety patients, 44 males and 46 females with a mean age of 54 years, were analyzed. The left/right distribution of the iliac crest donor site was 50/50 and 89% of the patients underwent a lumbar fusion below L3. Only 24% patients identified the harvest site correctly. Moreover, the VAS pain scores for the donor site and contralateral iliac crest did not differ and were at each timepoint lower than the scores for back pain. This study showed that, during the first year after lumbar fusion surgery via a single midline incision approach, patients could not reliably identify the iliac crest used for bone graft harvesting and this iliac crest was not more painful than the untouched contralateral iliac crest. Therefore, donor site pain should not be the main reason to use bone graft alternatives for lumbar spinal fusion. 2.

Morbidity of anterior iliac crest and calvarial bone donor graft sites: a 1-year randomized controlled trial

Autogenous bone graft harvesting is still commonly considered the gold standard for the reconstruction of a severely resorbed maxillary alveolar ridge; however, the preferred donor site remains a subject of debate. This study compared the morbidity of calvarial and iliac crest donor sites after harvesting. Twenty edentulous patients with an insufficient volume of maxillary bone for reliable implant placement were assigned randomly to either calvarial (n=10) or anterior iliac crest (n=10) bone harvesting groups. All patients underwent a maxillary sinus floor elevation procedure combined with widening of the alveolar process using buccal bone blocks. Donor site morbidity was assessed before, during, and at 1year after the surgery through patient questionnaires, physical examination, and medical records. No perioperative complications occurred. The anterior iliac crest group reported minor postoperative pain after harvesting. The scars after calvaria harvesting were significantly longer (P=0.003), but this was not bothersome for the group of patients. Long-term pain was negligible and satisfaction was high in both groups. Both the calvaria and anterior iliac crest are associated with low long-term donor site morbidity and high patient satisfaction. Thus, patient-centred decision-making is appropriate when selecting the preferred harvesting method for that patient.

Guide design in virtual planning for scapular tip free flap reconstruction.

BackgroundVirtual surgical planning (VSP), intraoperative cutting guides and stereolithographic models, provides the head and neck reconstructive surgeon with powerful tools for complex reconstruction planning. Despite its use in fibular osteocutaneous reconstruction, application to the scapular tip has not been as widely reported.MethodsFrom 2013 to 2014, four cases of either mandibular or maxillary reconstruction were completed with the scapular tip osseous free flap. All four cases underwent preoperative VSP with patient‐specific guide design.ResultsPatient‐specific guides were generated for scapular tip harvest. Guide placement was improved using a stabilizing flange and bracket design. With minimal disruption of the overlying periosteum a wedge osteotomy was successfully implemented in one case.ConclusionsUnlike the fibula and iliac crest donor sites, the scapular tip has overlying muscle attachments that make intraoperative osteotomies challenging. Attention to key aspects of scapular anatomy, including the fibrous tip and extensive overlying muscle, permits effective guide design.Level of evidence4

Comprehensive analysis of the volume of bone for grafting that can be harvested from iliac crest donor sites

Our aim was to calculate the volumes of cancellous, cortical, and corticocancellous bone that can be harvested as a graft from the anterior and posterior iliac crests using 3-dimensional computed tomography (CT) and software in a living adult population. We selected random CT scans of the pelvis from 31 men and 29 women from the Department of Radiology imaging database. CT data in DICOM file format were imported into Mimics software. The anterior iliac crest and posterior iliac crest bone graft-harvested boundaries were measured. The volume of the 3-dimensional cortical and cancellous bone grafts was measured using the Mimics software. There were significant differences in all comparisons between the anterior and posterior iliac crest, except for volumes of cortical bone. More cancellous and total corticocancellous bone can be harvested from the posterior than the anterior iliac crest, together with similar or smaller volumes of cortical bone. Sex, but not age, is an important factor in terms of the amount of bone that can be harvested, with a wide range of volumes individually from both iliac crests.

Clinical outcome of ISOBAR TTL dynamic stabilization with pars bone grafting for treatment of lumbar spondylolysis

To evaluate the effectiveness of ISOBAR TTL dynamic stabilization with pars bone grafting for the treatment of lumbar spondylolysis. A retrospective analysis was made the clinical data of 26 patients with lumbar spondylolysis who received ISOBAR TTL dynamic stabilization with pars bone grafting between September 2009 and March 2014. There were 14 males and 12 females, with a mean age of 31 years (range, 19-47 years). The disease duration ranged from 9 to 60 months (mean, 16 months). Preoperative lumbar anteroposterior and lateral X-ray films, CT three-dimensional reconstruction, and MRI scans were performed to identify the location of pars defect. The involved levels were L 4 in 9 cases and L 5 in 17 cases. There were 10 cases of pure spondylolysis and 16 cases of spondylolysis accompanied with I degree slipping. The clinical outcome was assessed by visual analogue scale (VAS) and Oswestry disability index (ODI) scores at preoperation and 1 week, 3 months, 6 months after operation, and at last follow-up. The lumbar CT three-dimensional reconstruction was obtained at 6 months after operation to evaluate bone fusion of the pars. The adjacent segment degeneration was assessed by the University of California at Los Angeles (UCLA) grading scale at preoperation and last follow-up. All incisions healed by first intention; no infection, cerebrospinal fluid leakage, or pain at iliac crest donor site occurred. Twenty-six patients were followed up 2-5 years (mean, 36.5 months). No secondary spondylolisthesis, internal fixation loosening and breakage were found during follow-up. The postoperative VAS and ODI scores showed significant differences ( P<0.05) when compared with preoperative scores, and the scores at 3 months, 6 months, and last follow-up were significantly better than that at 1 week ( P<0.05), but no significant difference was shown between the other time points after operation ( P>0.05). The CT three-dimensional reconstruction indicated satisfactory union at the pars in 23 cases (88.5%) at 6 months after operation. Of the 3 nonunion patients, good union was obtained in 1 patient at 1 year after operation; nonunion was observed in 2 patients at last follow-up, but low back pain was obviously alleviated. According to the UCLA grading scale, 20 cases were rated as grade I and 6 cases as grade II at last follow-up, which was the same as preoperative grade and indicated no adjacent segment degeneration. It is safe and effective to use the ISOBAR TTL dynamic stabilization with pars bone grafting technique to treat lumbar spondylolysis with or without degree I slipping. The fusion rate is satisfactory, and adjacent segment degeneration can be slowed down after lumbar fusion surgery.

Percutaneous Fixation for Scaphoid Nonunion With Bone Grafting Through the Distal Insertion Hole of a Fully Threaded Headless Screw

Objective: Percutaneous scaphoid screw fixation is a popular treatment for acute scaphoid fractures with no or minimal displacement. For treating scaphoid nonunions, however, open reduction and internal fixation with bone grafting is still the most popular treatment. Percutaneous fixation with bone grafting through the screw insertion hole has received little attention, although it minimizes damage to the surrounding tissues. We report excellent results of 10 scaphoid nonunions treated by retrograde percutaneous fixation with curettage and bone grafting through the distal insertion hole of a fully threaded headless screw. Materials and Methods: Ten scaphoid nonunions with substantial bone loss were treated, including 1 revision case. All nonunions were located at the middle third of the scaphoid. The mean patient age at operation was 24.7 years, and the mean interval between fracture and surgery was 8.8 months. In the revision case, the interval between the primary and revision surgery was 6 months. Surgery was performed under general anesthesia or an axillary brachial plexus block with local anesthesia at the iliac crest donor site. A 1.1-mm guidewire was percutaneously inserted into the scaphoid tuberosity and advanced to the proximal pole of the scaphoid with the wrist in an extended and ulnar-deviated position. A 1.2-mm second derotation wire was also inserted radial or ulnar to the original guidewire. A 2.0-mm cannulated drill was passed over the guidewire, stopping at the distal end of the cystic lesion. The guidewire was then removed. The 1.2-mm second derotation wire maintained the reduction of the scaphoid. Curettage inside the cystic lesion was performed using a small curette inserted through the distal insertion hole. Bone graft was harvested percutaneously from the iliac crest with an 11-gauge bone biopsy needle and inserted into the cystic lesion through the drill hole of the distal scaphoid fragment. The removed guidewire was reinserted into the previously drilled hole followed by insertion of a selected fully threaded headless screw (Acutrak 2 mini; Acumed, Hillsboro, OR, USA). After the operation, the wrist was immobilized in a thumb spica cast for the initial 6 weeks, followed by splinting until bone union was confirmed. In one case, curettage alone was performed before retrograde insertion of the headless screw. In the other cases including the revision, curettage and bone grafting with a bone biopsy needle was required through a distal insertion hole. Results: The mean follow-up was 12.1 months. Radiologically, union was achieved at averaged 12 weeks postoperatively. At the final follow-up, there was significant improvement in the wrist extension range of movement (from 65.8° to 80.8°) and grip strength (from 65.5% to 87.8% of the unaffected side). Nine patients were free of pain, and 1 experienced mild pain only during heavy manual labor. The mean visual analogue scale (VAS), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Cooney wrist scores were 0.1, 1.75, and 98.5, respectively. All patients returned to their work or athletic activities. Conclusions: Retrograde percutaneous fixation with bone grafting through the distal insertion hole of a fully threaded headless screw is a promising option for surgical treatment of scaphoid nonunions.

Smith-Robinson Procedure with an Autologous Iliac Crest for Degenerative Cervical Disc Disease: A 28-Year Follow-Up of 95 Patients

Long-term clinical results after anterior cervical discectomy and fusion (ACDF) with an autologous iliac crest are rare. The purpose of this study was to assess this, with special focus on pain, functional outcome, and repeat surgery for adjacent segment disease (ASD). Hospital records of 212 patients who were affected by degenerative cervical disc disease and treated by the Smith-Robinson technique were reviewed. Information about diagnosis, surgery, pre- and postoperative clinical process, and complications was analyzed. Patients were reviewed with a standardized questionnaire including the current neurologic status, Neck Disability Index, EQ-5D, Patient Satisfaction Index, Odom criteria, and limitations in quality of life. Ninety-five patients with a mean follow-up of 28 years were evaluated. ACDF was performed at 1 level in 67 and 2 levels in 28 patients. Ninety-two patients reported pain before surgery and 68 patients remained pain free and did not require second surgery. At follow-up, the mean Neck Disability Index was 14%, and mean EQ-5D score was 5. Postoperatively, 96.8% of patients were satisfied and 84.2% of patients reported good to excellent functional recovery. One patient had a hairline fracture at the iliac crest donor site. Fourteen patients underwent second surgery because of degenerative changes, including 11 at the symptomatic ASD. ACDF yields significant decrease in pain, a significant increase in function, and a high degree of patient satisfaction. Overall prevalence for ASD was 12.0% after 25 years. Patients with reoperation had similar clinical outcome regarding pain, compared with patients without reoperation.

Anatomic feasibility of a new endopelvic approach for iliac crest bone harvesting.

For the past few years, anterior exposure for surgery of the lumbar spine has gained popularity for the treatment of disk disease or spondylosis. Cancellous bone remains the gold standard for fusion. Iliac crest bone harvesting is safe but there are donor site complications. Bone substitutes exist, like recombinant human bone morphogenic protein-2 rhBMP-2. This alternative offers a high rate of fusion but with local and general complications. The aim of our study is to show the feasibility of an endopelvic approach for iliac bone crest harvesting to avoid donor site complication. Twenty anterior retroperitoneal lumbar spine approaches have been realized in the anatomy department of the University of Bordeaux. The volumes of cancellous bone have been measured and procedure complications have been reported. The mean volume of cancellous bone was 5.9cc, the maximum volume was 8.2cc and the minimum volume was 4.5cc. No complications have been reported during the approach or the bone harvesting. Anterior retroperitoneal approach for iliac bone crest harvesting is a safe way to obtain sufficient volume of cancellous bone for a single lumbar spinal fusion. This exposure avoids the risks of an iliac crest donor site complications or rhBMP-2 complications.

Iliac Crest Donor Site for Children With Cleft Lip and Palate Undergoing Alveolar Bone Grafting: A Long-term Assessment.

The authors aimed to accurately assess the donor site morbidity from iliac crest bone grafts for secondary bone grafting in patients with cleft lip and palate alveolar defects. Fifty patients between 3 months and 10 years following alveolar bone grafting for cleft lip and palate were entered into the study. Two-thirds of patients had no significant concerns about the donor site. The remaining third had some concerns about the appearance of their hips and less than 10% of patients expressing strong agreement with statements about concerns with shape, appearance, and self-consciousness about the iliac crest donor site. Examination findings showed the average length of scar being 5.4 cm and a third of patients having some minor palpable boney irregularities of the iliac crest. The authors found that the alveolar crest donor site is well tolerated by patients long term but has a measurable morbidity long term.

Use of the On-Q Pain Pump in Alveolar Bone Grafting: Effect on Hospital Length of Stay.

Alveolar bone grafting (ABG) with iliac crest bone graft can be associated with significant pain at the donor site. The On-Q pain pump has been shown to be efficacious in treating postsurgical pain. The aim of this study was to compare the length of postoperative hospital stay in patients undergoing ABG who received the On-Q pain pump at the iliac crest donor site (On-Q+) with that of patients who did not receive the On-Q pain pump (On-Q-). A retrospective, cohort study, approved by institutional review board, was performed. Thirty-one consecutive patients in the On-Q- group were compared with 38 consecutive patients in the On-Q+ group. The two cohorts were assessed for length of stay. Statistical analysis was performed using the Fisher exact probability test. Tertiary care academic medical center. Sixty-nine patients with cleft lip and/or cleft palate (CL/P) undergoing secondary ABG with iliac crest bone graft were operated on between May 1993 and January 2014. Length of postoperative hospital stay. Mean length of stay in the On-Q- patients was 0.52 days versus 0.37 days for the On-Q+ patients. This difference between the two cohorts was not statistically significant (P = .234). Although there is a trend toward a shorter length of stay in our patients who received the On-Q pump, this finding was not statistically significant. Given the expense and additional burden of care associated with the device, we have become more selective in its utilization.

Anterior discectomy/corpectomy and fusion with internal fixation for the treatment of unstable hangman's fractures: a retrospective study of 38 cases.

The object of this study was to describe the authors' method of anterior discectomy/corpectomy and fusion combined with internal fixation for the treatment of unstable hangman's fractures and to evaluate the clinical and radiological outcomes. This study included 38 consecutive patients who underwent surgery for unstable hangman's fractures between July 2002 and October 2011 and were followed up for more than 2 years. The patients were 18 women and 20 men with a mean age of 42.8 years (range 20-69 years). The fracture resulted from a fall in 9 patients, a motor vehicle accident in 21 patients, and a motorcycle accident in 8 patients. The Levine-Edwards classification was Type II in 13 patients, Type IIA in 20 patients, and Type III in 5 patients. All patients underwent anterior C2-3 intervertebral disc excision or C-3 corpectomy, decompression and reduction, interbody implantation of an autologous iliac bone graft, and internal fixation with a titanium plate. Pain was assessed before and after surgery using a visual analog scale (VAS). Myelopathy was graded using the Japanese Orthopaedic Association (JOA) score. Patient satisfaction with the surgery was assessed using Odom's grading system. Anteroposterior, lateral, and dynamic (flexion/extension) radiographs were obtained during the follow-up period. Two-dimensional CT studies with sagittal and coronal reconstructions were routinely performed. The mean follow-up period was 49.2 months (range 24-132 months). There was a significant decrease between the preoperative and final follow-up VAS scores (mean [SD] 7.56 ± 1.52 vs 2.36 ± 1.25, p < 0.05) and a significant increase between the preoperative and final follow-up JOA scores (12.58 ± 1.34 vs 16.13 ± 1.17, p < 0.05). Postoperative radiographs showed satisfactory reduction of the fracture in all cases. Postoperative complications included transient neurological deficits (3 cases), hematoma (2 cases), temporary dysphagia (5 cases), temporary hoarseness (2 cases), prolonged pain at the iliac crest donor site (4 cases), and wound infection at the iliac crest donor site (2 cases). Solid fusion was achieved in 94.7% of patients at the final follow-up. Anterior discectomy/corpectomy and fusion combined with internal fixation is a safe and effective procedure for the treatment of unstable hangman's fractures.

Results of 10-year follow-up of the iliac donor site of graft patients.

To measure levels of pain and iliac regeneration at the iliac crest donor site during a 10-year follow-up of graft patients. This prospective study used a visual analogue scale (VAS) to assess pain at the donor site at 1 month and 1, 3, 5 and 10 years postoperatively. Iliac regeneration status was recorded at 1, 3, 5, 7 and 10 years postoperatively by comparing plain radiographs. A total of 32 patients participated in the study. Mean VAS scores at 1 month, 1 year, 3, 5, and 10 years were 3.22, 3.39, 3.45, 2.02 and 1.38, respectively. There was no statistically significant difference between pain scores at 1 month and 1 year, but pairwise comparisons revealed significant differences between the other timepoints. The mean iliac regeneration rank scores at 1, 3, 5, 7 and 10 years were 1.36, 2.22, 2.97, 3.75 and 4.70, respectively; all pairwise comparisons were statistically significant. The iliac donor site showed a declining trend in pain, which appeared to have started 3 years postoperatively. Long-term follow-up showed that the ilium is readily able to repair itself.