Reconstruction of iliac crest with rib to prevent donor site complications: A prospective study of 26 cases

Bone and parietal anterior iliac crest reconstruction for trans-iliac hernia after tricortical graft harvesting: An original technique

Tricortical cortico-cancellous bone allografts from the anterior iliac crest are routinely used in revision arthroplasty and to treat non-union. Trans-iliac herniation (TIH) has been reported as an exceptional complication after extensive graft harvesting. The various reconstruction techniques include isolated parietal reconstruction and combined parietal and bone reconstruction using allografts or a spacer to reconstruct the bone defect. No previous study has evaluated a combined reconstruction technique involving both bone reconstruction with a titanium plate and abdominal wall reconstruction with a parietal reinforcement prosthesis. This technical note describes the evaluation of an original combined reconstruction technique used after failure of isolated parietal reconstruction to treat TIH. Through a direct approach to the anterior iliac crest, the bone defect was repaired using a flexible titanium cranio-facial reconstruction plate and the abdominal wall defect using a polypropylene/poliglecaprone parietal reinforcement prosthesis. This original technique was demonstrated to be effective for treating TIH, with no recurrence after 2.5 years of follow-up. In addition, this technique involves no added morbidity related, for instance, to allograft using or spacer migration.

Kirschner Wire and Bone Cement is a Viable Alternative to Reconstruction of Large Iliac Bone Defects After Strut Bone Graft Harvesting

STUDY DESIGN

A retrospective study.

OBJECTIVE

To assess the safety and efficacy of iliac crest defect reconstruction using Kirschner wire (K-wire)/polymethylmethacrylate (PMMA) versus traditional autologous rib graft reconstruction.

SUMMARY OF BACKGROUND DATA

The iliac crest has been the preferred donor site for strut bone graft for various spinal fusion surgeries.

METHODS

Seventy-three patients (44 males and 29 females; average age: 57.2 y) were divided into 2 groups: the rib group (35 patients) and the K-wire/PMMA group (38 patients). All operations involved anterior spinal interbody fusion. Patients were followed-up, on average, for 34.2 months using plain radiographs and both pain and cosmesis visual analog scales (VAS) to assess the clinical results after surgery.

RESULTS

Almost all patients had pain VAS scores of ≤1 and grade 1 cosmesis VAS scores with no significant difference between the 2 groups in terms of either pain or cosmesis (P=1.00 and 0.505, respectively). In addition, few complications were noted in both groups. Radiographic complications in the rib group and the K-wire group numbered 4 (11%) and 2 (5%), respectively; however, did not significantly differ between the 2 groups (P=0.418). One case required intraoperative revision of the length of the K-wire and 1 case needed reoperation for iliac ring fracture and K-wire migration. An additional case required revision due to a bad fall.

CONCLUSIONS

K-wire and bone cement reconstruction is an effective and safe alternative method for large iliac bone defect repair when autologous rib graft is not available.

Reconstruction of iliac crest with bovine cancellous allograft after bone graft harvest for symphysis pubis arthrodesis

PURPOSE

The aim of this study was to evaluate the safety and efficiency, as well as the incorporation characteristics of a specific type of xenograft used for iliac crest defects post-harvesting tri-cortical iliac crest bone graft.

METHODS

Sixteen patients diagnosed with chronic anterior pelvic pain were operated for pubic symphysis fusion. The tri-cortical graft harvested from the iliac crest was inserted into the pubic symphysis and compressed with a reconstruction plate. The defect in the iliac crest was filled with a block of cancellous bovine substitute (Tutobone®). The length of iliac crest defect, time to fusion of pubic symphysis, time to incorporation of the graft and complications were recorded. The postoperative pain and patients' satisfaction were evaluated.

RESULTS

The median age of patients was 36.5 years (range 27-75). Fusion was obtained in 15 patients (94 %). The median time to fusion was four months (range three to seven). The length of the iliac crest bone defect ranged from 40 to 70 mm. Integration of the bovine substitute was achieved in 15 patients (94 %) over a median period of three months (range two to six). The postoperative median pain score was 2 (range 1-5). Twelve patients (75 %) reported good satisfaction. No major complications or allergic reactions were observed.

CONCLUSIONS

The xenograft used in this study provided a safe and effective method of reconstruction of iliac crest donor site defects. It has satisfactory incorporation, high biocompatibility and no signs of inflammatory reactions. This new technique is simple and easily reproducible in routine clinical practice.

Reconstruction versus no reconstruction of iliac crest defects following harvest for spinal fusion: a systematic review: A review

OBJECT

Autologous bone from the iliac crest is commonly used for spinal fusion. However, its use is associated with significant donor site morbidity, especially pain. Reconstructive procedures of the iatrogenic defect have been investigated as a technique to alleviate these symptoms. The goal of this study was to assess the effects of reconstruction versus no reconstruction following iliac crest harvest in adults undergoing spine surgery.

METHODS

The authors searched the Cochrane Central Register of Controlled Trials (The Cochrane Library 2011, Issue 4); MEDLINE (1948-Oct 2011); EMBASE (1947-Oct 2011); and the reference lists of articles. Randomized controlled trials (RCTs) or nonrandomized controlled trials (NRCTs) were included in the study. Two independent reviewers selected the studies, extracted data using a standardized collection form, and assessed for risk of bias.

RESULTS

Three RCTs (96 patients) and 2 NRCTs (82 patients) were included. These had a moderate to high risk of bias. The results suggest that iliac crest reconstruction may be useful in reducing postoperative pain, minimizing functional disability, and improving cosmesis. No pattern of other clinical, radiological, or resource outcomes was identified.

CONCLUSIONS

Although the available evidence is suboptimal, this systematic review supports the notion that iliac crest reconstruction following harvest for spinal fusion may reduce postoperative pain, minimize functional disability, and improve cosmesis.

Can iliac crest reconstruction reduce donor site morbidity?: a study using degradable hydroxyapatite-bioactive glass ceramic composite

STUDY DESIGN

Prospective study.

OBJECTIVE

To prospectively validate the hypothesis that iliac crest donor site morbidity may be a structural issue and by reconstructing the crest its incidence might be reduced. The study also evaluates the efficacy of Chitra hydroxyapatite-bioactive glass ceramic composite (Chitra-HABG) as a material for reconstructing the iliac crest.

SUMMARY OF BACKGROUND DATA

Tricortical iliac crest bone graft harvesting is associated with significant donor site morbidity, varying from 3% to 61%. Reconstruction of the defect has been shown to reduce this morbidity, but the only materials which have been shown to be useful and readily available are bioactive apatite-wollastonite glass ceramic and morcellized beta-tricalcium phosphate.

METHODS

Twenty-six patients in whom tricortical graft was harvested from the iliac crest and defect reconstructed with an indigenously developed and tested graft substitute-Chitra HABG-were followed up to duration of 1 year. Outcome measures were donor site morbidity as assessed clinically and radiologic assessment for ceramic incorporation, dissolution, fragmentation, and migration.

RESULTS

At the end of 1 year from surgery, 25 of the 26 patients (96.15%) had no pain at the donor site, which had been reconstructed. Radiologic evaluation showed that in 21 cases the ceramic incorporation was complete, partial in 3, and absent in 2. Partial dissolution of ceramic was noticed in 3 patients and migration in 1.

CONCLUSIONS

This study validates our hypothesis that the donor site morbidity after tricortical iliac crest graft harvesting is probably a structural issue and it can be reduced by reconstruction of the defect. It also highlights the fact that the Chitra-HABG block is an excellent material for reconstruction of the iliac crest defect, as it gets incorporated into the surrounding bone without adverse effects.