Elsevier

World Neurosurgery

Volume 106, October 2017, Pages 764-767
World Neurosurgery

Technical Note
Endopelvic Approach for Iliac Crest Bone Harvesting

https://doi.org/10.1016/j.wneu.2017.07.091Get rights and content

Background

The anterior approach to lumbar spine surgery has grown in popularity in the past few years; spinal fusion of the last 2 lumbar levels is often required. Although alternatives to bone grafting are available, including recombinant human bone morphogenetic protein 2 or bone substitutes, only cancellous autologous bone has all the required factors for bone growth. To avoid the use of bone substitutes, remote iliac crest bone harvesting remains the gold standard. However, this technique may lead to some unfavorable outcomes.

Case Description

The patient was a 46-year-old man with severe back and left leg pain. Magnetic resonance imaging showed an inflammatory discopathy of L5-S1 associated with a left posterior lateral herniated disc. Conservative treatment failed, and surgical treatment of the lumbar disk disease and the herniated disc was scheduled. A novel iliac crest bone harvesting method was performed during the retroperitoneal approach to the anterior lumbar interbody fusion. The patient's postoperative course was uneventful. There were no adverse outcomes related to the bone donor site.

Conclusions

This is the first in vivo report of endopelvic iliac crest bone harvesting. This technique allows bone graft harvesting to be performed with the same retroperitoneal approach used for anterior lumbar interbody fusion. It avoids many common complications associated with the remote approach to the iliac crest.

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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