Showing papers on "Iliac crest published in 1997"
TL;DR: The mean Sickness Impact Profile score for patients completing questionnaires was nine, suggesting most patients were functioning well 2 years postoperatively, and the morbidity of iliac crest grafting remains substantial.
Abstract: Functional outcomes and complications experienced by adult patients who underwent iliac crest bone grafting were evaluated to assess the effect of bone grafts on patient function. In addition to retrospective chart reviews, patients completed the Sickness Impact Profile and a detailed questionnaire on pain. One hundred ninety-two patients met study inclusion criteria. Major complications were recorded in four (2.4%) patients in whom infections developed requiring readmission. Thirty-seven (21.8%) patients had minor complications. One hundred nineteen of 170 patients were available for followup; of these 119 patients, 87 (73.1%) returned completed questionnaires. Thirty-three of 87 (37.9%) patients reported pain 6 months postoperatively. The incidence of pain decreased with time, with 16 of 87 (18.7%) patients continuing to report pain more than 2 years postoperatively. Proportionately more spine patients reported pain at all time points. The mean Sickness Impact Profile score for patients completing questionnaires was nine, suggesting most patients were functioning well 2 years postoperatively. The morbidity of iliac crest grafting remains substantial. Pain symptoms in this study sample seemed to last longer in more patients than earlier series have indicated. Minimizing muscle dissection around donor sites and the advent of bone graft substitutes may help alleviate these problems.
868 citations
TL;DR: The success rate for vascularized bone grafting is high and is the treatment of choice when primary reconstruction is required, when the patient has been previously irradiated, or when simultaneous replacement of soft tissue is required.
390 citations
TL;DR: The identification of patients at risk for minor complications suggests that allograft may be appropriate in these patients; however, prospective comparison is required to identify whether graft material or technical factors determine fusion success and relative benefit.
Abstract: STUDY DESIGN Retrospective study of 184 autologous iliac crest bone grafts used for anterior cervical fusion in 144 procedures. OBJECTIVES To evaluate the effect of autologous iliac crest bone graft harvest site on operation and recovery and to identify patients at risk for harvest morbidity. SUMMARY OF BACKGROUND DATA Although autologous iliac crest bone graft is considered the most successful grafting material, concerns about harvest morbidity provide a rationale for considering allograft. Data about the use of autograft therefore would assist spinal surgeons in selecting the appropriate substrates for fusion after anterior cervical decompression. METHODS Statistical analysis based on patient gender, smoking history, obesity, and medical or pharmacologic risk factors for wound healing was used to evaluate morbidity after patient interviews and examinations. Limited assessment of radiographic outcome also was performed. RESULTS A second operation because of donor site morbidity was performed in four patients (2.8%), but only one (0.7%) with meralgia paresthetica had permanent sequelae. Superficial wound infection or dehiscence occurred in 5.6% of patients, with a disproportionate number of women, obese patients, and those with medical risk represented. Protracted wound symptoms of pain and poor cosmesis were reported in 2.8% and 3.5% of patients, respectively, and also were found in a significant number of female and obese patients. Evidence of fusion was present in 97% of cases. CONCLUSION Autologous iliac crest bone graft harvest results in minimal major morbidity when regional anatomy is respected and careful technique is observed. The identification of patients at risk for minor complications suggests that allograft may be appropriate in these patients; however, prospective comparison is required to identify whether graft material or technical factors determine fusion success and relative benefit.
270 citations
TL;DR: The results of this study suggest that the lateral femoral cutaneous nerve is most susceptible to mechanical trauma when the nerve is type A, B, or C.
Abstract: The anatomy of the lateral femoral cutaneous nerve was investigated through dissection of 52 human anatomic specimens. The variability of its course and locations as it exists the pelvis is described and related to soft-tissue and bony landmarks. Five different types are identified: type A, posterior to the anterior superior iliac spine, across the iliac crest (4 percent); type B, anterior to the anterior superior iliac spine and superficial to the origin of the sartorius muscle but within the substance of the inguinal ligament (27 percent); type C, medial to the anterior superior iliac spine, ensheathed in the tendinous origin of the sartorius muscle (23 percent); type D, medial to the origin of the sartorius muscle located in an interval between the tendon of the sartorius muscle and thick fascia of the iliopsoas muscle deep to the inguinal ligament (26 percent); and type E, most medial and embedded in loose connective tissue, deep to the inguinal ligament, overlying the thin fascia of the iliopsoas muscle, and contributing the femoral branch of the genitofemoral nerve (20 percent). The results of this study suggest that the lateral femoral cutaneous nerve is most susceptible to mechanical trauma when the nerve is type A, B, or C.
228 citations
TL;DR: For traumatic defects of long bones that necessitate grafting, use of the composite graft material appears to be justified on the grounds of safety, efficacy, and elimination of the increased operative time and risk involved in obtaining an autogenous graft from the iliac crest.
Abstract: A prospective, randomized clinical trial was conducted concurrently at eighteen medical centers in order to compare the safety and efficacy of two types of graft material for the treatment of fractures of long bones: autogenous bone graft obtained from the iliac crest, and a composite material composed of purified bovine collagen, a biphasic calcium-phosphate ceramic, and autogenous marrow. Two hundred and thirteen patients (249 fractures) were followed for a minimum of twenty-four months to monitor healing and the occurrence of complications. We observed no significant differences between the two treatment groups with respect to rates of union (p = 0.94, power = 88 per cent) or functional measures (use of analgesics, pain with activities of daily living, and impairment in activities of daily living; p > 0.10). The prevalence of complications did not differ between the treatment groups except for the rate of infection, which was higher in the patients who were managed with an autogenous graft. Twelve patients who were managed with a synthetic graft had a positive antibody titer to bovine collagen; seven of them agreed to have intradermal challenge with bovine collagen. One patient had a positive skin response to the challenge but had no complications with regard to healing of the fracture. We concluded that, for traumatic defects of long bones that necessitate grafting, use of the composite graft material appears to be justified on the grounds of safety, efficacy, and elimination of the increased operative time and risk involved in obtaining an autogenous graft from the iliac crest.
214 citations
TL;DR: Donor site morbidity was significantly less when iliac bone was harvested with a trephine (inlay group) than in patients treated with the authors' routine procedure for bone harvesting ( inlay/onlay group).
152 citations
TL;DR: This work repaired an extensive, primary lumbar hernia laparoscopically, securing the mesh to the 12th rib superiorly, iliac crest inferiorly, erector spinae fascia medially, and external oblique fascia laterally, the first report of this technique.
Abstract: Lumbar hernias are rare defects that involve the extrusion of retroperitoneal fat or viscera through a weakness in the posterior abdominal wall. Repairing these hernias is often difficult because of the weakness of the surrounding structures. Techniques for reconstruction usually include an incision from the 12th rib to the iliac crest with mobilization of local flaps or onlay fascial flaps or the use of prosthetic mesh. Contemporary reports have advocated extensive retroperitoneal dissection with the placement of permanent mesh extraperitoneally. We have recently repaired an extensive, primary lumbar hernia laparoscopically, securing the mesh to the 12th rib superiorly, iliac crest inferiorly, erector spinae fascia medially, and external oblique fascia laterally. The patient resumed normal activities in less than 2 weeks; 4 months postoperatively, he seems to have a solid repair. To our knowledge, this is the first report of this technique.
151 citations
TL;DR: Thirteen patients who received an onlay bone graft augmentation to their severely atrophic mandible in combination with a simultaneous implant insertion were studied prospectively and it was concluded that the described surgical technique should be used only if there are stringent indications.
137 citations
TL;DR: Higher percentages of nonunion were noted in multilevel interbody grafting than in corpectomy with strut grafting and when more vertebral levels were involved, which underscores the shortcomings of multileVEL anterior cervical allograft reconstruction with plating.
Abstract: This retrospective study evaluated a single surgeon's series of patients treated by multilevel cervical disc excision (two or three levels), allograft tricortical iliac crest arthrodesis, and anterior instrumentation. The objective of this retrospective study was to compare fusion success and clinical outcome between multilevel Smith-Robinson interbody grafting and tricortical iliac strut graft reconstruction, both supplemented with anterior instrumentation in the cervical spine. The incidence of nonunion for cervical discectomy and fusion varies widely depending on the number of disc levels involved, type of bone graft used, and whether the anterior grafting is supplemented with instrumentation. An alternative to multilevel interbody fusion is corpectomy and strut grafting, in which the incidence of nonunion has been reported to be 27% with autograft and 41% with allograft. Sixty-four consecutive patients who underwent allograft tricortical iliac crest reconstruction and anterior cervical plating were studied. The average follow-up was 39 months. There were 38 patients in the discectomy and interbody grafting group and 26 patients in the corpectomy and strut graft reconstruction group. Pseudoarthrosis occurred in 42% of the anterior cervical interbody fusion patients and 31% of the corpectomy patients. Nonunion in two-level interbody fusions occurred in 36% of the patients as compared to 10% for patients with one-level corpectomies; while 54% of patients with three-level interbody fusions and 44% of patients with two-level corpectomies were noted to have pseudoarthrosis. Higher percentages of nonunion were noted in multilevel interbody grafting than in corpectomy with strut grafting and when more vertebral levels were involved. These radiographic and clinical findings underscore the shortcomings of multilevel anterior cervical allograft reconstruction with plating. Corpectomy may be the preferred method when multiple disc levels are fused. In addition, anterior corpectomy affords decompression of significant osteophytes in a safer and quicker manner. In retrospective studies, there is a need for long-term follow-up before accurate statements can be made about the study population.
134 citations
TL;DR: It is suggested that patients who are receiving corticosteroid therapy or who abuse alcohol have decreased activity of bone-marrow cells, which may be related to the osteonecrosis.
Abstract: The bone-marrow activity in the iliac crest of eleven patients who had idiopathic osteonecrosis of the hip and thirty patients who had osteonecrosis of the hip that was related to corticosteroid therapy (fourteen patients) or to alcohol abuse (sixteen patients) was compared with that in two
131 citations
TL;DR: Re recombinant human bone morphogenetic protein (rhBMP-2), when added to autograft, significantly increased the volume and the maturity of the resulting fusion mass, and Polylactic/glycolic acid (PLGA) sites were associated with a greater incidence of voids within the fusion mass.
Abstract: This study evaluated the use of recombinant human bone morphogenetic protein (rhBMP-2) with various types of carrier media, and the effect of rhBMP-2 as an adjunct to autogenous iliac crest bone graft in the canine spinal fusion model. BMP induces mesenchymal cells to differentiate into cartilage and bone. The recent availability of rhBMP-2 has created the opportunity to evaluate this material's properties in augmenting autogenous bone graft in spinal fusion. Currently, the most appropriate type of carrier media for rhBMP-2 is undetermined. Bilateral intertransverse spinal fusions were performed on six canine lumbar spines at L1-L2, L3-L4, and L5-L6, using autogenous posterior iliac crest bone graft at each level, creating a total of 18 segmental fusion sites. All 18 sites were then randomly assigned to one of six fusion methods: autogenous bone graft (ABG) alone, ABG + rhBMP-2, ABG + collagen (Helistat) "sandwich" + rhBMP-2, ABG + collagen (Helistat) morsels + rhBMP-2, ABG + polylactic/glycolic acid sponge (PLGA) sandwich + rhBMP-2, and ABG + open-pore polylactic acid morsels + rhBMP-2. Each material was evaluated for ease of handling and application at the index surgery. The animals underwent computed tomography (CT) scanning of the lumbar fusion sites after 8 weeks. Volumetric measurements of total fusion mass at each level were performed using two-dimensional CT scan slices and a volumetric program supplied by the Siemens Medical System. The animals were killed after imaging studies. The lumbar spine fusion sites were evaluated for integrity of the fusion mass, both visually and with manual mechanical stressing. Crossover of the fusion mass to adjoining levels was also evaluated. Histologic evaluation of all fusion sites was performed. The addition of rhBMP-2 significantly increased bone graft volume as noted on CT scan. Carrier that could be mixed with morselized bone graft offered easier handling and application and all spine segments fused. Polylactic/glycolic acid (PLGA) sites were associated with a greater incidence of voids within the fusion mass. No significant difference in carrier media for rhBMP-2 could be determined. However, PLGA was associated with a higher rate of fusion mass void formation. rhBMP-2, when added to autograft, significantly increased the volume and the maturity of the resulting fusion mass.
TL;DR: In selected patients with low back pain, medial superior cluneal nerve entrapment compromise at the posterior iliac crest crossing site is ascertain, and the results of nerve release are evaluated.
Abstract: Study design In this study, the authors analyzed the results of the release of the medial superior cluneal nerve in a prospective series of 19 patients with suspected entrapment. Objectives To ascertain, in selected patients with low back pain, medial superior cluneal nerve entrapment compromise at the posterior iliac crest crossing site, and to evaluate the results of nerve release. Summary of background data A cadaveric study had shown that the medial superior cluneal nerve may be compressed at its transit site through an osseofibrous orifice at the posterior iliac crest. Methods Nineteen patients suffering from unilateral low back pain projecting in the territory of the medial superior cluneal nerve, with a trigger point at the posterior iliac crest and with a positive block test at this level, underwent surgery. Results Results were excellent in 13 cases (7 of which had suffered from severe compression), and unsatisfactory in 6 cases (including 4 cases in whom no compression could be demonstrated). Conclusion Entrapment neuropathy of the medial superior cluneal nerve is a rare and easily treatable cause of unilateral low back pain.
TL;DR: It is concluded that primary arthrodesis and instrumentation can be performed in acute spinal infections; however, successful management depends on aggressive debridement of infectious foci and prolonged treatment with parenteral antibiotic drugs.
Abstract: Primary reconstruction using bone grafts and instrumentation for spinal infections remains controversial. Between 1991 and 1993, 27 infections of the spinal column were treated at the Department of Neurosurgery of the University of Florida. Of the 27 cases 20 (six cervical, eight thoracic, and six lumbar spine) required surgical debridement and spinal reconstruction to maximize eradication of the infection and maintenance of spinal alignment. All of the cervical and lumbar cases were caused by bacterial infections, and two of eight thoracic cases were caused by tuberculous infections. Spinal arthrodesis was performed in all cases: interbody grafts were used in 18 procedures and posterolateral onlay grafts in 14. Interbody grafts were autologous in 10 cases (six rib and four iliac crest) and allograft in eight (six fibular and two humerus). All of the posterolateral onlay grafts were autologous (three rib and 11 iliac crest). Spinal instrumentation was used in 15 cases: four with Caspar plates and 11 with posterior segmental fixation (five hook/rod constructs and six screw/rod constructs). Seventeen of 20 patients achieved improved clinical status postoperatively and 18 of 20 showed radiographic evidence of bone fusion. Antibiotic drugs were administered parenterally for an average of 6 weeks followed by a 3-month course of oral antibiotic medications. Tuberculous infections were treated for 1 year with antibiotic therapy. The average follow-up period was 37 months from surgery and 31 months after completion of treatment with antibiotic drugs. The authors conclude that primary arthrodesis and instrumentation can be performed in acute spinal infections; however, successful management depends on aggressive debridement of infectious foci and prolonged treatment with parenteral antibiotic drugs.
TL;DR: Numbness, tenderness, and pain at the donor site one and six months postoperatively were assessed by means of an interview with the patient and a review of the records.
Abstract: We compared the donor site morbidity in fifty-seven consecutive patients in whom a bone graft had been procured from the iliac crest through an incision parallel to the superior cluneal nerves and perpendicular to the posterior iliac crest (the study group) with that in fifty-three consecutive patients in whom the graft had been procured through an oblique incision parallel to the posterior iliac crest (the control group). Numbness, tenderness, and pain at the donor site one and six months postoperatively were assessed by means of an interview with the patient and a review of the records. The prevalence of symptoms in the control group was greater than that in the study group. At one month, thirty-nine patients (74 per cent) in the control group had numbness, compared with twenty-five (44 per cent) in the study group (p = 0.001). At six months, thirty-one patients (58 per cent) in the control group had numbness, compared with fourteen (25 per cent) in the study group (p = 0.0002). Thirty-six patients (68 per cent) in the control group and twenty-four (42 per cent) in the study group had tenderness over the incision at one month (p = 0.005), and twenty-seven (51 per cent) and eleven (19 per cent), respectively, had tenderness at six months (p = 0.0003). Forty patients (75 per cent) in the control group and forty-six patients (81 per cent) in the study group had deep pain in the region of the iliac crest at one month, compared with thirty-two (60 per cent) and thirty-one (54 per cent), respectively, at six months. The mean analog score for pain at the donor site was 7 of 10 points in the control group and 6 points in the study group (p = 0.001) at one month and 3 and 2 points, respectively, at six months (p = 0.001).
TL;DR: BMD is low in both the axial and peripheral skeleton in men with AS and is independent of spinal immobilization, and Anterioposterior lumbar spine DXA in late AS is less useful than QCT in determining the degree of osteopenia.
TL;DR: The data imply that a global assessment of skeletal function and bone quality, based upon analyses at one anatomical site, should be applied with caution, and support the hypothesis of an IGF-I-mediated pathogenesis of senile osteoporosis.
Abstract: Skeletal site-related differences in trabecular bone composition have been studied in autopsy samples from 63 individuals (age range 23-92 years). From each individual, bone samples were excised from the iliac crest, lumbar spine, femoral neck, and calcaneus. Samples were analyzed for their content of ash, calcium, collagen, extractable proteins, osteocalcin, and IGF-I. Significant differences were found between the skeletal sites, the lumbar spine being the least mineralized site and the femur the most. The femur and lumbar spine had a higher osteocalcin and IGF-I content compared with the other skeletal sites, suggesting a higher bone turnover rate. The intercorrelations between the anatomical sites were low for minerals and collagen but high for osteocalcin and IGF-I. The latter might indicate that the presence of these proteins in the bone matrix is mainly controlled by endocrine mechanisms which may influence the osteoblast function. Finally, regression analysis showed a significant age-related decrease of skeletal IGF-I at all sites examined. This finding supports the hypothesis of an IGF-I-mediated pathogenesis of senile osteoporosis. In summary, our data imply that a global assessment of skeletal function and bone quality, based upon analyses at one anatomical site, should be applied with caution.
TL;DR: The implants Inserted in the fibulae showed the highest removal torques as compared to the ones inserted in the iliac crests and the scapulae, and the removal torque was related to the thickness of the cortical bone in the implant sites.
Abstract: This study was undertaken to compare removal torque of endosseous implants in the fibula, iliac crest and scapula of cadavers. The fibulae, iliac crests and scapulae were harvested from the right side of 5 formalin-preserved cadavers. Endosseous implants (Brinemark System®) were placed at 3 points of each bone. The removal torque of the implant was measured by a torque gauge manometer (Tohnichi 15 BTG-N). After measurement of there moval torque, the bone was cut at each implant site. The thicknesses of cortical and total bone were measured, The mean removal torques were 46.3 N cm in the fibulae, 15.2 N cm in the iliac crests and 2 1.4 N cm in the scapulae. There was a statistically significant difference in mean removal torque between the three bones. The total bone thicknesses were 11.7 mm in the fibulae, 9.9 mm in the iliac crests and 8.2 mm in the scapulae. The cortical bone thicknesses were 5.0 mm in the fibulae, 1.6 mm in the iliac crests and 1.8 mm in the scapulae. Significant correlation between the removal torque and the cortical bone thickness was found. However there was no significant correlation between the removal torque and the total bone thickness. In conclusion, the implants inserted in the fibulae showed the highest removal torques as compared to the ones inserted in the iliac crests and the scapulae. Moreover the removal torque was related to the thickness of the cortical bone in the implant sites.
TL;DR: A negative effect of calcitonin on bone quality is found and this results point to a decrease in bone formation and mineralization rates and an increase in mineralization lag time.
Abstract: Because of its antiresorptive properties, calcitonin is widely used to prevent and treat osteoporosis. A stimulatory effect of calcitonin on osteoblasts has also been reported; however, a recent histologic study points to a negative effect of calcitonin on mineralization of cancellous bone. The present experiment was performed to determine whether the observed histological signs of alterations in mineralization are also observed in cortical bone and whether this results in changes in mechanical properties, mineral densities, or mineral properties of canine bone. Sixteen female adult beagle dogs were randomly allocated to receive either human calcitonin at a dose of 0.25 mg/dog (50 IU, n = 8) or vehicle (mannitol, n = 8) every other day for 16 weeks. At the end of the study, the dogs were euthanized. Both tibiae, L1 and L5 vertebrae, and iliac crest bone samples were excised and defleshed. Torsional mechanical properties of tibial diaphyses and compressive strengths of vertebrae were measured. Bone mineral densities (BMD) of tibiae and vertebrae were measured by using dual-energy X-ray absorptiometry. Ultrastructural mineral characteristics of iliac crest bone were determined by gravimetry and Fourier transform infrared spectroscopy (FTIR). Bone histomorphometry was performed in the cortical envelope of the iliac crest. Tibiae from dogs treated with calcitonin withstood significantly less maximum torque until failure, required less torsional energy to reach the maximum torque, and had less torsional stiffness than the tibiae from dogs treated with vehicle (p < 0.05). Cancellous cores of vertebrae from calcitonin-treated dogs withstood less compressive mechanical loading than did vertebral cores from vehicle-treated animals (p < 0.05). Dogs treated with calcitonin had less BMD of both tibiae and vertebrae than vehicle-treated animals (p < 0.05). Bones from calcitonin-treated dogs had significantly less ash content, which correlated with the lower phosphate-to-amide I (detected by FTIR) and greater carbonate-to-phosphate ratios than did bones from vehicle-treated dogs (p < 0.05). Calcitonin-treated dogs exhibited a decrease in bone formation and mineralization rates and an increase in mineralization lag time. These results point to a negative effect of calcitonin on bone quality. These findings are intriguing and call for further studies addressing whether the observed abnormalities are transient or permanent.
TL;DR: Harvesting cancellous bone from the iliac crest does not result in delayed ambulation or prolonged hospitalization, and the volume of bone was sufficient in all but one case.
TL;DR: The experience of tricortical interposition iliac crest grafting in the management of late pain and deformity after calcaneus fracture led to two technique modifications that were evaluated in this study.
Abstract: We are reporting our experience using tricortical interposition iliac crest grafting in the management of late pain and deformity after calcaneus fracture. Ten patients underwent this procedure, which was performed by the senior author. All but one were followed up with a questionnaire, physical examination, and repeat x-rays. The technique failed in one severely osteoporotic individual because of the graft sinking into the calcaneus. The experience led to two technique modifications that were evaluated in this study.
TL;DR: It is concluded that vascularized PBG is sometimes indicated for ANFH in an early stage before collapse of the femoral head with nontraumtic and steroid-induced avascular necrosis treated with vascularized iliac pedicle bone graft.
Abstract: We investigated the results of 31 hips in 26 patients with nontraumtic (n = 20) and steroid-induced (n = 6) avascular necrosis of the femoral head (ANFH) treated with vascularized iliac pedicle bone graft (PBG). The average age at operation was 38.3 years. Three were women and 23 men. The average follow-up was 8.0 years. The Harris hip score prior to operation and at latest follow-up improved from 62 to 83; one hip collapsed and was revised with a bipolar endoprosthesis. At the final follow-up, 19 hips (63%) were clinically rated as good to excellent, 4 fair, and 7 poor. At the final follow-up, 15 of 27 hips (56%) of stage II before operation showed progressive collapse after bone grafting. In steroid-induced ANFH, in three women, 2 of 4 hips showed poor results. These results are only slightly better than those of core decompression and no better than those obtained after decompression and simple nonvascularized grafts to provide support for the subchondral bone. We concluded that vascularized PBG is sometimes indicated for ANFH in an early stage before collapse of the femoral head.
TL;DR: The iliac crest free flap has undergone a gradual evolution to provide more functional and cosmetic oromandibular reconstructions as discussed by the authors, but the soft-tissue cutaneous component has largely resisted refinement and currently constitutes the flap's principal drawback.
Abstract: The iliac crest free flap has undergone a gradual evolution to provide more functional and cosmetic oromandibular reconstructions. The soft-tissue cutaneous component has largely resisted refinement and currently constitutes the flap's principal drawback. Conventionally, the cutaneous vessel's soft-tissue encasement and a protective cuff of abdominal muscle are harvested to ensure skin perfusion. These protective measures, however, produce a bulky flap that is tethered to the bone and difficult to inset into complex three-dimensional defects. A series of anatomic and clinical investigations has confirmed that in 30 percent of individuals, the skin island can be elevated on a dominant cutaneous branch from the deep circumflex iliac artery. Harvesting the skin as an axial pattern flap greatly increases its independence from the bone, improving maneuverability. A small collar of abdominal muscle is incised around the pedicle, obviating the need for the customary 2.5-cm protective muscle cuff. Exclusion of the abdominal muscular component reduces the flap's volume, decreases the need for secondary debulking, and reduces the donor site morbidity.
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TL;DR: The successful use of osseointegrated implants to replace posterior teeth combined with the autogenous bone graft technique in the sinus compares favorably with previous reports in terms of implant survival and stability.
Abstract: This study reports the successful use of osseointegrated implants to replace posterior teeth combined with the autogenous bone graft technique in the sinus. Preliminary data (1 to 6 years experience) of this one-stage procedure are presented. A total of 33 patients were treated - 44 sinus grafts were augmented with bone from the anterior iliac crest. Reconstruction was completed with ceramic fixed partial dentures, and there was a follow-up of 3 to 80 months (mean 40.2 months) after loading. None of the 44 sinus grafts was lost. Of the 121 implants placed, eight failed, resulting in a failure rate of 6.6% and a cumulative failure rate of 6.8%. Of the 44 prostheses placed in the 44 sinuses, one failed, resulting in a prosthesis stability of 97.7%. Complications were encountered in three patients (three sinuses, eight implants); treatments were administered, symptoms subsided, and the implants integrated in two patients (two sinuses, six implants). One patient lost the two implants and the prosthesis, but the graft integrated. No other complications have since occurred. The results compare favorably with previous reports in terms of implant survival and stability. The implant survival rate approached that of implants placed in uncompro- mised maxillary bone.
TL;DR: Preliminary results indicate that this surgical procedure is suitable for reconstruction of most atrophic maxillas.
TL;DR: Diagnostic imaging is essential for optimal staging in malignant lymphoma, as blind biopsies appear to have low sensitivity for bone marrow infiltration because of frequent involvement in noncrest marrow.
Abstract: PURPOSETo compare the diagnostic accuracy of magnetic resonance imaging (MRI) and immunoscintigraphy (IS) for detection of bone marrow infiltration in malignant lymphoma.PATIENTS AND METHODSIn 32 patients with Hodgkin's disease (HD) or non-Hodgkin's lymphoma (NHL), MRI of the axial skeleton and whole-body IS using technetium-99m (99mTc)-labeled monoclonal antibodies were reviewed and compared with iliac crest biopsies. Criterion for marrow infiltration was a positive biopsy or concordant positive results of MRI and IS.RESULTSIn 16 patients (50%), MRI, IS, and iliac crest biopsies were negative for marrow infiltration. Iliac crest biopsy showed infiltration in only four patients (13%). Infiltration was missed in two of 32 patients with IS and in one patient with MRI. In one additional patient, MRI was false-positive because of pelvic hematopoietic hyperplasia. A subset of nine patients (28%) with negative biopsies had bone marrow involvement according to MRI and IS with identical location and pattern of in...
TL;DR: This nondestructive assessment of strength of iliac crest bone biopsies thereby enables biomechanical information as well as histomorphometric measurements to be obtained from the same biopsy.
TL;DR: In this article, the authors analyzed retrospectively 1191 cases of bone graft harvesting of the iliac crest which had been performed at our hospital between 1982 and 1991, and found that the operative revision rate was 2.8%.
Abstract: We analyzed retrospectively 1191 cases of bone graft harvesting of the iliac crest which had been performed at our hospital between 1982 and 1991. There was an operative revision rate of 2.8%. For further study, we analyzed the clinical reports of all autograft (iliac crest) donors in a representative year (1991) and re-examined all those who still had symptoms. A total of 104 grafts were taken from 97 patients. Of these, 18 developed postoperative complications (19.6%), such as hematoma, which could usually be treated with local procedures such as aspiration. The rate of hematoma tended to be lower in those patients who had received a local coagulant, but this was not significant. Of the patients 55% still had problems 1 year after operation at the time of re-examination, but in most cases they were minor, for example, local irritation or discomfort. Serious problems developed in those patients who had a palpable defect of the iliac crest. We advise using local coagulants to decrease the rate of postoperative complications, although we cannot statistically prove the effect. When large grafts are harvested, the iliac crest should be reconstructed for better long-term results.
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TL;DR: The aim of this study was to seek in vitro, using cell cloning techniques, anomalies of bone marrow from non union site, and it was surprising that progenitors were also sparse in the bone marrow of the iliac crest of patients with non union, compared with control bone marrow donors.
Abstract: PURPOSE OF THE STUDY: The recent observations that osteoblasts develop from a stem cell found in the medullary stroma suggest that, as already suspected in classical histological studies, many consolidation mechanisms are based on bone marrow Since cells characteristics can now be studied in tissue culture, it has become possible to investigate the activity of the bone marrow in non union The working hypothesis for this study was: if the bone marrow plays a part in bony callus formation, bone marrow from non union site should manifest anomalous activity whatever the origin of the focus sampled Therefore, the aim of this study was to seek in vitro, using cell cloning techniques, anomalies of bone marrow from non union site MATERIALS: The study characterizes the bone marrow from 35 non union sites, not only with respect to the medullary stroma but also the hematopoietic compartment In this study, we look for systemic anomalies which could explain susceptibility to non union, we also compare in vitro activity of bone marrow taken from non union with others samples taken from the iliac crest of the same patient METHODS: The cell density in the bone marrow in these sites was studied in vitro with material taken from the non union site Samples were taken by aspiration with a trocar located by image intensification Assays of CFU-GM were chosen to quantify the hematopoietic activity of the marrow, and of CFU-F to quantify stroma cells activity Cell densities in the non union site were compared to those in patients' own iliac crests, and also to iliac crests densities of a control population of bone marrow donors RESULTS: The bone marrow of non union site contained low levels of progenitor cells Especially surprising was that progenitors were also sparse in the bone marrow of the iliac crest of patients with non union, compared with control bone marrow donors In several cases, certain general factors are probably responsible for the abnormally low levels of progenitor cells, not only in the non union site, but also in the iliac crest
TL;DR: Fascia lata can be harvested safely in the region of the iliac crest with an inconspicuous scar and with fewer complications than with the more traditional site slightly above the lateral knee.
Journal Article•
TL;DR: The values found in non union sites and extension regenerated fibrous tissue suggest that there are relatively few F-CFU to differentiate into fibroblasts, as a result of some general physiological problem (chemotherapy, smoking, alcoholic poisoning).
Abstract: PURPOSE This study characterizes the bone marrow from 35 non union sites, not only with respect to the medullary stroma but also the hematopoietic compartment. In this study, we looked for systemic anomalies which could explain susceptibility to non union. We also compare the in vitro activity of bone marrow taken from non union sites with that of samples taken from the iliac crest, of the same patient. MATERIAL AND METHODS We included 6 groups: 26 cases of post-traumatic non union. 2 cases of non union following arthrodesis of the knee for infected prosthesis, 1 case of a non union of a tibiotarsal arthrodesis. 4 cases of regenerated illizarov extensions, which showed no evidence of ossification three months after operation, 2 cases of patients suffering from congenital abnormalities. Samples were taken from a population of 30 "bone marrow donors", to act as controls for the iliac crest samples. RESULTS Cell density in the iliac crest bone marrow of non union patients is significantly lower than that of controls (p < 0.01). In the hematopoietic compartment of the bone marrow, the number of progenitors (GM-CFU) obtained after culture of iliac crest bone marrow is consistently lower for patients presenting a non union than for controls (p < 0.01). Only infection of non union site (4 cases) seems to be associated with an increase in GM-CFU in the iliac crest. The difference in the average number of F-CFU obtained after culture of bone marrow from non union patients and from controls is lower but is nevertheless significant. 14 of the non union patients have less than half the F-CFU observed as normal in controls and 10 of them yielded less than one quarter. Out of these ten patients, in whom non union was associated with a marked abnormality in the number of F-CFU in the iliac crest (less than one quarter of the total obtained from controls), in 8 cases were other factor or disease which could account for the abnormality such as age (2 cases), clear alcoholic intoxication (1 case), heavy smoking (2 cases), history of chemotherapy (2 cases), and Lobstein's disease (1 case). The values found in non union sites and extension regenerated fibrous tissue suggest that there are relatively few F-CFU to differentiate into fibroblasts. In 12 out of 35 patients studied, the bone marrow generated no F-CFU. Same patients have abnormal low levels of F-CFU obtainable from their iliac crest bone marrow. The number of GM-CFU in fracture site is also extremely low. No local increases in GM-CFU levels are seen in septic focuses. The population of F-CFU and GM-CFU vary with time, in the same patient, at the same site of aspiration. Higher levels of osteogenic activity are seen at the beginning of extension. CONCLUSION This study suggests that problems related to consolidation may be linked with an overall reduction of bone marrow progenitor cells, as a result of some general physiological problem (chemotherapy, smoking, alcoholic poisoning).