Technical NoteEndopelvic Approach for Iliac Crest Bone Harvesting
Introduction
Anterior lumbar interbody fusion (ALIF) has increased in popularity among spine surgeons in the past few years. This procedure is used to treat several diseases such as lumbar spondylosis or lumbar disk disease. The most treated levels are L4-L5 and L5-S1.1 Cancellous bone remains the gold standard for spinal fusion, but iliac crest bone harvesting may lead to donor-site complications.2, 3 Using bone substitutes such as recombinant human bone morphogenetic protein 2 can also promote fusion. Recombinant human bone morphogenetic protein 2 is associated with a high rate of fusion, but serious complications have been reported.4 In the present case, a new endopelvic iliac crest bone harvesting method is performed using the same retroperitoneal approach as the ALIF procedure.
Section snippets
Case Description
The reported case is that of a 46-year-old man with no medical or surgical history. For 2 years before surgery, the patient reported low back pain accompanying left S1 radicular pain. Although he received conservative treatment including rehabilitation, physiotherapy, and pain medications, the symptoms gradually worsened. Magnetic resonance imaging showed an L5-S1 discopathy associated with Modic type I5 signal and a left posterolateral herniated disc (Figure 1). A standard retroperitoneal
Discussion
The anterior approach used for lumbar spine procedures has many advantages. The retroperitoneal exposure of the lumbar spine allows for increasing the intervertebral space and lordosis, minimizing the risk of neural injury and avoiding damage to the back muscles.1 Decreasing excessive muscle lesions increases oxygen and nutrient factors for bone growth. To obtain good fusion rates, the lumbar interbody cage should be filled with materials that promote bone growth. Autologous bone remains the
Conclusions
Fusion in anterior lumbar spine surgery is always challenging. When the choice is made to use cancellous bone, endopelvic iliac bone crest harvesting may be used. Using autologous cancellous bone avoids complications associated with the use of bone substitutes such as bone morphogenetic protein. The retroperitoneal approach avoids the usual complications of remote iliac crest harvesting. Paying attention to the neurologic anatomy and achieving good hemostasis might avoid complications of this
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