Spontaneous Posterior Iliac Crest Regeneration Enabling Second Bone Graft Harvest: A Case Report


Patrick F. O'Leary, MD, FACS, PC

Patrick F. O'Leary, MD, FACS, PC

Associate Attending Orthopaedic Surgeon, Hospital for Special Surgery
Associate Professor of Orthopedic Surgery, Weill Cornell Medical College

Federico P. Girardi, MD

Federico P. Girardi, MD

Attending Orthopaedic Surgeon, Hospital for Special Surgery
Professor of Orthopaedic Surgery, Weill Cornell Medical College
Associate Scientist, Research Division, Hospital for Special Surgery

 

Elias C. Papadopoulos
University of Athens, School of Medicine, Orthopedic Department, Spine Service, Athens, Greece
Spine Service, Hospital for Special Surgery

 

Ioannis P. Pappou
Spine Service, Hospital for Special Surgery
Department of Orthopedic Surgery, University of Kentucky, Lexington, KY

Abstract

We present a case of a revision spinal fusion in which successful bone graft reharvesting was performed from the posterior iliac crest 4 years after initial intracortical harvesting. To date, only anterior iliac crest regeneration has been reported in orthopedic trauma patients. A 70-year-old man with a history of two prior instrumented lumbar fusion operations developed thoracolumbar kyphosis junctional to the lumbosacral fusion mass. His first operation was an instrumented posterolateral lumbar fusion L1 to L5, where bone graft was harvested from the right iliac crest using the intracortical harvesting technique. The second procedure was performed 18 months later and consisted of an extension of the fusion to the sacrum due to L5–S1 level derived symptoms. The bone graft for this procedure was taken with the same technique from the left iliac crest. The development of thoracolumbar junctional kyphosis necessitated the third operation, which consisted of a same-day anterior–posterior extension of the fusion to T10. Prior to this third procedure, a spinal computer tomography was performed that documented regeneration of the cancellous bone in the right iliac crest. This permitted reharvesting of almost 40 ml of cancellous bone using the intracortical bone harvesting technique from the right iliac crest. Histological analysis showed mature bone. Cancellous bone regeneration and restoration of the local anatomy of the ilium are possible after intracortical bone harvesting. This regeneration can provide autologous bone graft to assist fusion in subsequent operations.

This article appears in HSS Journal: Volume 5, Number 2.
View the full article at springerlink.com.

About the HSS Journal

HSS Journal, an academic peer-reviewed journal, is published twice a year, February and September, and features articles by internal faculty and HSS alumni that present current research and clinical work in the field of musculoskeletal medicine performed at HSS, including research articles, surgical procedures, and case reports.

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