Showing papers on "Iliac crest published in 2012"

Qualitative and quantitative differences between bone graft obtained from the medullary canal (with a Reamer/Irrigator/Aspirator) and the iliac crest of the same patient.

Abstract: Background: Donor site morbidity and limited volume remain primary drawbacks of using bone graft from the iliac crest and an impetus for finding other sources of autologous bone-graft material. The Synthes Reamer/Irrigator/Aspirator (RIA) has beenfoundtohavevalueasanautologousbone-graftharvestingdevice.Thepurposeofthisstudywastocomparethecellular and biochemical characteristics of bone grafts obtained with use of the RIA and from the iliac crest of the same patient. Methods: A prospective study was performed on a consecutive series of ten skeletally mature patients presenting for repair of nonunited tibial or femoral fractures. Graft material was harvested from both the iliac crest (in the standard fashion) and the medullary canal of the femur or tibia (with use of the RIA) of each patient. Portions of each autologous graft sample were assessed histologically and by genomewide transcriptional profiling for biochemical markers known to be expressed during fracture-healing. Results: Principal-component analysis comparing the messenger RNA expression profiles in the RIA and iliac crest samples showed that the expression profile at each harvest site was unique and independent of patient, age, sex, or any identified comorbidity. Transcriptional analysis showed that the RIA samples had greater levels of expression of genes associated with vascular, skeletal, and hematopoietic tissues. Additionally, stem cell markers and growth factors that act early in the osteogenic cascade were more abundant in the RIA samples compared with the iliac crest samples. Conclusions: This is the first study to directly compare the histological and molecular profiles of bone grafts from reamingdebrisand theiliaccrestof thesamepatient. Thedebrisgeneratedduringintramedullaryreaming,harvestedwith use of the RIA technique, and the bone graft harvested from the iliac crest possessed a similar transcriptional profile for genes known to act in the early stages of bone repair and formation. This suggests that reaming debris may be a viable alternative to iliac crest bone graft when autologous cancellous graft is needed.

Differences in Bone Quality in Low- and High-Turnover Renal Osteodystrophy

Abstract: Abnormal bone turnover is common in CKD, but its effects on bone quality remain unclear. We qualitatively screened iliac crest bone specimens from patients on dialysis to identify those patients with low (n=18) or high (n=17) bone turnover. In addition, we obtained control bone specimens from 12 healthy volunteers with normal kidney function. In the patient and control specimens, Fourier transform infrared spectroscopy and nanoindentation quantified the material and mechanical properties of the specimens, and we used bone histomorphometry to assess parameters of bone microstructure and bone formation and resorption. Compared with high or normal turnover, bone with low turnover had microstructural abnormalities such as lower cancellous bone volume and reduced trabecular thickness. Compared with normal or low turnover, bone with high turnover had material and nanomechanical abnormalities such as reduced mineral to matrix ratio and lower stiffness. These data suggest that turnover-related alterations in bone quality may contribute to the diminished mechanical competence of bone in CKD, albeit through different mechanisms. Therapies tailored specifically to low- or high-turnover bone may treat renal osteodystrophy more effectively.

Volumetric changes of the graft after maxillary sinus floor augmentation with Bio-Oss and autogenous bone in different ratios: a radiographic study in minipigs.

Abstract: Objective: The objective of the present study was to learn about the volumetric changes of the graft after maxillary sinus floor augmentation with Bio-Oss and autogenous bone from the iliac crest or the mandible in different ratios in minipigs. Material and methods: Bilateral maxillary sinus floor augmentation was performed in 40 minipigs with: (A) 100% autogenous bone, (B) 75% autogenous bone and 25% Bio-Oss, (C) 50% autogenous bone and 50% Bio-Oss, (D) 25% autogenous bone and 75% Bio-Oss, and (E) 100% Bio-Oss. The autogenous bone graft was harvested from the iliac crest or the mandible and the graft composition was selected at random and placed concomitant with implant placement. Computed tomographies of the maxillary sinuses were obtained preoperatively, immediately postoperatively, and at euthanasia after 12 weeks. The volumetric changes of the graft were estimated using the Cavalieri principle and expressed as mean percentage with a 95% confidence interval (CI). Results: The mean volume of the graft was reduced by (A) 65% (95% CI: 60–70%), (B) 38% (95% CI: 35–41%), (C) 23% (95% CI: 21–25%), (D) 16% (95% CI: 12–21%), and (E) 6% (95% CI: 4–8%). The volumetric reduction was significantly influenced by the ratio of Bio-Oss and autogenous bone (P<0.001), but not by the origin of the autogenous bone graft (P=0.2). Conclusions: The volume of autogenous bone grafts from the iliac crest and the mandible is reduced significantly after maxillary sinus floor augmentation in minipigs. The graft volume is better preserved after the addition of Bio-Oss and the volumetric reduction is significantly influenced by the ratio of Bio-Oss and autogenous bone. However, further studies are needed addressing the amount of new bone formation and bone-to-implant contact before the final conclusion can be made about the optimal ratio of Bio-Oss and autogenous bone. To cite this article: Jensen T, Schou S, Svendsen PA, Forman JL, Gundersen HJG, Terheyden H, Holmstrup P. Volumetric changes of the graft after maxillary sinus floor augmentation with Bio-Oss and autogenous bone in different ratios: a radiographic study in minipigs. Clin. Oral Impl. Res. 23, 2012; 902–910 doi: 10.1111/j.1600-0501.2011.02245.x

Bone morphogenetic protein in spine surgery: current and future uses.

Abstract: The clinical use of bone morphogenetic protein (BMP) in spinal fusion surgery has recently become controversial. After its approval by the US FDA in July 2002, BMP was adopted by many spine surgeons as a replacement for the more traditional iliac crest bone graft to avoid the complications associated with bone graft harvest. However, as broad clinical use escalated, reports increased of potentially serious complications associated with BMP. Controversy continues, particularly regarding the safety of BMP and whether it should routinely replace iliac crest bone graft for spinal fusion surgery.

Risk factors predictive of chronic postsurgical neuropathic pain: the value of the iliac crest bone harvest model

Abstract: Nerve lesions and secondary hyperalgesia may both be present after surgery, and their relative contributions to chronic postsurgical neuropathic pain (CPSNP) remain unclear. This prospective study explored the roles of these factors in the development of CPSNP after iliac crest bone harvest. CPSNP was defined as pain in the area of hypoesthesia, with a positive Douleur neuropathique 4 questionnaire (DN4) score 3 months after iliac crest bone harvest. The location, intensity, and neuropathic characteristics of pain were evaluated in 82 patients who were followed for 6 months. Neuropathic characteristics were assessed by clinical examination and DN4 questionnaire. The area of secondary hyperalgesia was evaluated 48 h and 1 month after surgery. The area of mechanical hypoesthesia, detection, and mechanical pain threshold were evaluated at 48 h and at 1 and 3 months. Nineteen patients (23%) had CPSNP at 3 months. The patients who developed CPSNP had a larger area of secondary hyperalgesia at 48 h (88 cm(2) vs 33 cm(2); P=.001), higher pain intensity (numerical rating scale 6.7 vs 4.7; P=.02), and higher neuropathic characteristics score on the DN4 questionnaire (4.3 vs 2.3; P=.001). However, neither the area nor the severity of hypoesthesia differed significantly between patients with and without CPSNP. Two independent, additive predictors of CPSNP were identified: area of secondary hyperalgesia (odds ratio 1.02; P=.004) and DN4 score (odds ratio 1.94; P=.001). These findings suggest that both nerve lesions and central sensitization are involved in CPSNP development and could be seen as early warning signs.

Prospective observational study of donor-site morbidity following anterior iliac crest bone-grafting in orthopaedic trauma reconstruction patients.

Abstract: Background: Complications associated with iliac crest bone-graft donor sites have been reported. This prospective study was conducted to determine the prevalence of pain and complications at the iliac crest donor site in patients undergoing treatment of fracture nonunion. Methods: Ninety-two patients undergoing anterior iliac crest bone-grafting for nonunion or delayed union of a long-bone fracture were prospectively enrolled. Twenty-seven patients undergoing an alternative surgical treatment were enrolled as a control group. Questionnaires including pain on a visual analog scale (0 to 10) at the donor site were completed by patients at two weeks, six weeks, three months, and one year postoperatively. Short Form-36 (SF-36) forms were completed at enrollment and at the time of final follow-up. Results: The mean pain on the visual analog scale at the donor site was 3.9 at two weeks but rapidly decreased to 1.4 at six weeks and reached 0.3 at one year or more postoperatively (p 3 at one year or more postoperatively. There were three deep infections (3%) at the donor site, and no patients had a permanent sensory deficit in the lateral femoral cutaneous nerve distribution. At the time of final follow-up (mean, twenty-two months), scores for the SF-36 bodily pain subscale were significantly higher in the iliac crest group than in the control group, indicating a greater improvement in overall bodily pain in the iliac crest group. Conclusions: Anterior iliac crest bone-grafting for nonunion was a well-tolerated procedure. Substantial, persistent pain at the iliac crest donor site occurred in 2% of patients. Iliac crest bone-grafting did not appear to impair function or well-being compared with alternative treatments. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Particulate vs. block bone grafts: three-dimensional changes in graft volume after reconstruction of the atrophic maxilla, a 2-year radiographic follow-up.

Abstract: Background Extensive alveolar bone resorption in the maxilla limits the possibility of successful placement and osseointegration of endosseous implants for future prosthetic rehabilitation. Autogenous bone from the iliac crest may be used as lateral onlays in the atrophic maxilla, both as block and particulate bone. To our knowledge, there is no three-dimensional 2-year follow-up study measuring the volumetric reduction of the augmented areas comparing particulate and block bone grafts. Purpose The aim of this study was to conduct a radiographic 2-year follow-up study, using computed tomographic (CT) images in order to evaluate and compare the extent of bone graft resorption in the frontal maxillae augmented by particulate (test) and block bone (control). Material and methods Eleven patients treated with iliac bone grafts and oral implants in the maxilla were followed with CT examinations directly post grafting and after 2 years. Result The volumetric changes after 6 months were extensive. Additionally, the changes in particulate bone tended to be larger after 2 years compared to block bone, using this protocol. However, the difference was not statistically significant. Conclusion The present follow-up study showed that there is radiographically complete integration and embedding of implants installed in grafted bone despite extensive initial graft resorption. There was no significant difference in the amount of volumetric reduction between particulate bone and block bone grafts.

Surgical Technique: A Percutaneous Method of Subcutaneous Fixation for the Anterior Pelvic Ring: The Pelvic Bridge

Abstract: Background Management of pelvic ring injuries using minimally invasive techniques may be desirable if reduction and stability can be achieved. We present a new technique, the anterior pelvic bridge, which is a percutaneous method of fixing the anterior pelvis through limited incisions over the iliac crest(s) and pubic symphysis.

Iliac crest autograft versus alternative constructs for anterior cervical spine surgery: Pros, cons, and costs

Abstract: Background: Grafting choices available for performing anterior cervical diskectomy/fusion (ACDF) procedures have become a major concern for spinal surgeons, and their institutions. The “gold standard”, iliac crest autograft, may still be the best and least expensive grafting option; it deserves to be reassessed along with the pros, cons, and costs for alternative grafts/spacers.

Alveolar bone grafting

Abstract: In the 1970s, Boyne and Sands published reports on a new technique for alveolar bone grafting. They recommended that only cancellous bone be used and that the procedure be undertaken in the mixed dentition prior to canine eruption. Alveolar bone grafting prior to canine eruption soon became a routine part of the protocol for 90% of European and North American cleft teams. Several uncertainties remain however, such as the specifics of the surgical and orthodontic procedures, type of bone and donor site, and the best way to manage the space in the dental arch. Probably the commonest timing of the bone graft falls between 8 and 11 years, however there has been a trend in some centres to graft earlier in the hope of better outcome for the unerupted incisors. The influence on maxillary growth of earlier grafting has not been ascertained. A wide range of donor sites has been use but iliac crest remains the most popular. Many teams perform orthodontics prior to grafting to correct severe segment displacement or align incisors to improve surgical access. Following grafting, absence of the lateral incisor may be managed with orthodontic space closure, placement of an implant or bridgework. The introduction of alveolar bone grafting probably represents one of the most significant clinical innovations in cleft care. Hopefully, advances in tissue engineering will replace the need for transplantation of autogenous bone, or will provide an in-situ biological solution to the generation of a continuous bone fill across the alveolar cleft.

Computer-assisted Mandibular Reconstruction with Vascularized Iliac Crest Bone Graft

Abstract: The intention of mandibular reconstructive surgery is to achieve maximum possible functionality, which means the restoration of masticatory function and speech with a good esthetic result. We compared five computer-assisted mandibular reconstructions with 15 conventional mandibular reconstructions performed using vascularized iliac crest bone grafts. Based on preoperative cone beam computed tomography (CBCT) or CT data imported into the specific surgical planning software, a surgical guide was designed by rapid prototyping that helped to exactly translate the virtual surgery plan into the operation site whereby it fit uniquely to the iliac donor site. The ischemic time of the graft was measured intraoperatively and the difference between the amount of bone removed and the amount of bone required was determined. In addition, 3 months after surgery patients had to score the esthetics of their outer appearance using a visual analog scale. In all patients the graft fit perfectly into the mandibular defect without major adjustments. The time for the shaping process of the transplant and the ischemic time were shorter than in the conventional grafting procedure. The virtual plan reduced the amount of bone removed to the required volume. The patients who underwent computer-assisted reconstruction had a higher degree of satisfaction with their outer appearance. Our clinical experience and the collected data suggest that the described method is very promising for optimizing the surgical result of mandibular reconstructions using iliac crest bone grafts and achieving an excellent esthetic outcome. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Evaluation of alveolar bone grafting using limited cone beam computed tomography

Abstract: Objective The objective of this study was to evaluate the bone resorption of alveolar bone grafting using LCBCT scan. Study Design This was a prospective study. Nineteen patients with alveolar cleft were divided into 2 groups depending on the spontaneous eruption of the permanent tooth. All patients underwent alveolar bone grafting with iliac crest cancellous bone. LCBCT scans were taken 1 month and 6 months postoperatively. Results LCBCT scans obtained the length, width, and height of the bone grafts. Three-dimensional (3D) reconstruction of the bone grafts enabled a valuable objective assessment of the graft volume. The resorption ratio was 10.4% when the permanent tooth erupted spontaneously into the graft. In the group with absence of the permanent tooth, the resorption ratio was 36.6%. Conclusion LCBCT scan and 3D reconstruction is a promising method for evaluation of the outcome of alveolar bone grafts. Bone grafts showed a high grade of resorption in patients lacking permanent tooth eruption.

All-arthroscopic implant-free iliac crest bone grafting: new technique and case report.

Abstract: Glenoid bone loss is a recognized risk for recurrent instability. Open J-graft augmentation has been reported as a well-established procedure for anterior shoulder instability. Few data are available on arthroscopic techniques for the repair of bony Bankart lesions. We describe an all-arthroscopic implant-free iliac crest bone grafting technique and present the case of a 32-year-old hockey player who underwent glenoid reconstruction using this novel arthroscopic repair technique after 2 failed soft-tissue procedures. After 13 months, the patient reached nearly full range of motion with a slight loss of external rotation. The computed tomography scan showed a restoration of the glenoid cavity and complete healing of the graft.

Host bone response to polyetheretherketone versus porous tantalum implants for cervical spinal fusion in a goat model

Abstract: Study design In vivo assessment of polyetheretherketone (PEEK) and porous tantalum (TM) cervical interbody fusion devices in a goat model. Objective Directly compare host bone response to PEEK and TM devices used for cervical interbody fusion. Summary of background data PEEK devices are widely used for anterior cervical discectomy and fusion but are nonporous and have limited surface area for bone attachment. Methods Twenty-five goats underwent single-level anterior cervical discectomy and fusion and were alternately implanted with TM (n = 13) or PEEK devices (n = 12) for 6, 12, and 26 weeks. Both devices contained a center graft hole (GH), filled with autograft bone from the animal's own iliac crest. The percentage of bone tissue around the implant, percentage of the implant surface in direct apposition with the host bone, and evidence of bone bridging through the implant GH were assessed by using backscattered electron imaging. Bone matrix mineral apposition rate was determined through fluorochrome double labeling, and sections were stained for histological analysis. Results The TM-implanted animals had significantly greater volumes of bone tissue at the implant interface than the PEEK animals at all-time points. The TM animals also had a significantly greater average mineral apposition rate in the GH region at 6 and 12 weeks than the PEEK animals. No difference was observed at 26 weeks. A greater number of TM-implanted animals demonstrated connection between the autograft bone and both vertebrae compared with the PEEK implants. Histological staining also showed that the TM devices elicited improved host bone attachment over the PEEK implants. Conclusion The TM implants supported bone growth into and around the implant margins better than the PEEK devices. TM's open cell porous structure facilitated host bone ingrowth and bone bridging through the device, which could be beneficial for long-term mechanical attachment and support in clinical applications.

Alveolar reconstruction in cleft patients: decreased morbidity and improved outcomes with supplemental demineralized bone matrix and cancellous allograft.

Abstract: Background The safety and efficacy of supplemental allograft combined with iliac crest autograft as a treatment for cleft alveolus defects is poorly characterized. The authors report the safety and efficacy of supplemental demineralized bone matrix and cancellous allograft with iliac crest bone autograft in cleft alveolar bone defects. Methods A retrospective review of one institution's experience with cleft alveolar bone defects treated with traditional open iliac crest bone graft alone (group 1) or minimal access iliac crest bone graft plus demineralized bone matrix and cancellous allograft (group 2) was performed. All patients (n = 36) were treated with alveolar fistula repair with primary closure. Results Twenty-two patients [17 unilateral and five bilateral clefts (n = 27)] were treated in group 1 and 14 [six unilateral clefts and eight bilateral clefts (n = 22)] in group 2. The average operative time per alveolus was 147 minutes in group 1 and 111 minutes in group 2. Average engraftment (Enemark Scale) was 1.96 in group 1 and 1.20 in group 2. In group 1, canine eruption was complete in 71.4 percent, partial in 21.4 percent, and unerupted in 3.5 percent; in group 2, canine eruption was complete in 22 percent, partial in 55 percent, and unerupted in 18 percent. Bone graft extrusion occurred in six patients in group 1. There were no wound infections or deaths. Conclusions The addition of supplemental demineralized bone matrix and cancellous allograft in cleft alveolar defects is safe and effective. The authors' allograft supplemental surgical technique is associated with low morbidity, shorter operative times, and higher rates of bone graft survival.

Hybrid grafting using bone marrow aspirate combined with porous β-tricalcium phosphate and trephine bone for lumbar posterolateral spinal fusion: a prospective, comparative study versus local bone grafting.

Abstract: Study design A prospective, comparative study. Objective We developed a hybrid graft (HBG) of porous β-tricalcium phosphate ceramics/percutaneously harvested bone sticks/autologous bone marrow aspirate for lumbar posterolateral fusion (PLF). The aim of this study was to investigate the efficacy of the HBG as a substitute for conventional corticocancellous iliac autografts. Summary of background data Iliac crest bone graft (ICBG) has been traditionally used as the golden standard for lumbar spinal fusion. The significant complication rate associated with harvesting corticocancellous ICBG, however, has encouraged development of alternative graft substitutes. Methods From September 2005, 61 consecutive patients underwent decompressive laminotomy and 1-level instrumented PLF. Each patient in this study had the constructs of the HBG placed on 1 side of the intertransverse process gutter. An autologous local bone graft (LBG) harvested during decompressive laminotomy was placed on the other side as a control. Radiographic evaluation was performed at 6 months, 1 year after surgery, and subsequently on an annual basis. The fusion statuses on either side of vertebra were compared. Results The flexion-extension motion in the dynamic x-rays at the target level decreased over time. Only 1 case exhibited over 5° of angular motion 2 years after surgery. In the evaluation of fusion status, the fusion rate for the HBG side (68.9% at 6 months, 83.6% at 1 year, 93.5% at 2 years) was higher than that for the LBG side (49.2% at 6 months, 75.4% at 1 year, 89.1% at 2 years) with a significant difference at 6 months after surgery. No significant complications at the donor site were found postoperatively. Conclusion The HBG promoted posterolateral spinal fusion without significant donor site morbidity. Because of its efficacy and safety, this hybrid construct seems promising as an alternative to conventional iliac bone grafts for lumbar spinal fusion.

The effect of iliac crest autograft on the outcome of fusion in the setting of degenerative spondylolisthesis: a subgroup analysis of the Spine Patient Outcomes Research Trial (SPORT).

Abstract: Background: There is considerable controversy about the long-term morbidity associated with the use of posterior autologous iliac crest bone graft for lumbar spine fusion procedures compared with the use of bone-graft substitutes. The hypothesis of this study was that there is no long-term difference in outcome for patients who had posterior lumbar fusion with or without iliac crest autograft. Methods: The study population includes patients enrolled in the degenerative spondylolisthesis cohort of the Spine Patient Outcomes Research Trial who underwent lumbar spinal fusion. Patients were divided according to whether they had or had not received posterior autologous iliac crest bone graft. Results: There were 108 patients who had fusion with iliac crest autograft and 246 who had fusion without iliac crest autograft. There were no baseline differences between groups in demographic characteristics, comorbidities, or baseline clinical scores. At baseline, the group that received iliac crest bone graft had an increased percentage of patients who had multilevel fusions (32% versus 21%; p = 0.033) and L5-S1 surgery (37% versus 26%; p = 0.031) compared with the group withoutiliaccrestautograft.Operativetimewashigherintheiliaccrestbone-graftgroup(233.4versus200.9minutes;p< 0.001), and there was a trend toward increased blood loss (686.9 versus 582.3; p = 0.057). There were no significant differences in postoperative complications, including infection or reoperation rates, between the groups. On the basis of the numbers available, no significant differences were detected between the groups treated with or without iliac crest bone graft with regard to the scores on Short Form-36, Oswestry Disability Index, Stenosis Bothersomeness Index, and Low Back Pain Bothersomeness Scale or the percent of patient satisfaction with symptoms averaged over the study period. Conclusions: The outcome scores associated with the use of posterior iliac crest bone graft for lumbar spinal fusion were not significantly lower than those after fusion without iliac crest autograft. Conversely, iliac crest bone-grafting was not associated with an increase in the complication rates or rates of reoperation. On the basis of these results, surgeons may choose to use iliac crest bone graft on a case-by-case basis for lumbar spinal fusion. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Morbidity associated with anterior iliac crest bone graft.

Abstract: Objective The aim of this retrospective study was to assess the morbidity of the harvest of the anterior iliac bone graft and the overall satisfaction rates in a group of patients who underwent harvesting of iliac crest bone graft Patients and Methods Patients who underwent iliac crest bone graft procedures from January 2002 to August 2009 were recalled and invited to answer a questionnaire about postoperative pain, sensory disturbance, functional limitations, and cosmetic appearance Results A total of 61 patients were included in this retrospective study Seventeen patients (28%) reported postoperative pain A patient reported an intraoperative hip fracture Sensory disturbances were reported by 3 patients Conclusions Anterior iliac crest can still be considered a favorable donor site for preprosthetic and cleft surgery Given its relatively low morbidity rate, early ambulation, and hospital discharge, anterior iliac crest still remains the donor site of choice according to the authors

Using computer simulation and stereomodel for accurate mandibular reconstruction with vascularized iliac crest flap.

Abstract: Objectives The aim of this study was to examine our patients who underwent accurate mandibular reconstruction with vascularized iliac crest flap using computer simulation and stereomodel and assess the postoperative results. Study design Fourteen patients were reviewed in this study. Bilateral iliac crests were automatically superimposed on the mandibular defects to select the optimal matching donor region in computer simulation. Operation was performed using stereomodels to replicate the preoperative planning. Actual reconstruction result was compared with computer simulation. The patients were asked to assess their satisfaction with facial appearance at 1 year after surgery. Results Bony unions and good occlusion were observed, and actual results were basically in accordance with computer simulation in 14 patients. Fourteen patients reported their facial appearance to be excellent or good at 1 year after surgery. Conclusions Accurate mandibular reconstruction with vascularized iliac crest flap using computer simulation and stereomodel may achieve the ideal contour of neomandible and good function after dental rehabilitation.

Posterolateral spinal fusion with nano-hydroxyapatite-collagen/PLA composite and autologous adipose-derived mesenchymal stem cells in a rabbit model.

Abstract: Spinal fusion is routinely performed to treat low back pain caused by degeneration of intervertebral discs. An autologous bone graft derived from the iliac crest is the standard procedure used for spinal fusion. However, several shortcomings, including pseudarthrosis, pain and the need for blood transfusion are known to be associated with the procedure. Our study analysed the effectiveness of a new mineralized collagen matrix, nano-hydroxyapatite–collagen–polylactic acid (nHAC–PLA), combined with autologous adipose-derived mesenchymal stem cells (ADMSCs) as a graft material for posterolateral spinal fusion in a rabbit model. Forty rabbits were randomly divided into four groups: autologous iliac crest bone group (ACB), nHAC–PLA composite group (nHAC–PLA), autologous iliac crest bone mixed with nHAC–PLA composite group (ACB + nHAC–PLA), and nHAC–PLA composite combined with ADMSCs (ADMSCs + nHAC–PLA). The viability and the proliferation of the ADMSCs seeded on the scaffolds were evaluated by live/dead kit and MTT assay in vitro, respectively. Lumbar posterolateral fusions were assessed by manual palpation, radiographical and histological procedures, mechanical strength and scanning electronic microscopy (SEM) in 10 weeks of observation. The results showed that the rate of fusion was significantly higher in the ACB and ADMSCs + nHAC–PLA groups than that in the nHAC–PLA and ACB + nHAC–PLA groups. It was not significantly higher in the ACB group than in the ADMSCs + nHAC–PLA group. From microstructural analysis of the samples using histological staining methods, there was more new bone-like tissue formation in the ACB and ADMSCs + nHAC–PLA groups than that in the other two groups at the 10th postoperative week. Our study demonstrated the effective impact of nHAC–PLA combined with ADMSCs in rabbit posterolateral spinal fusion. Copyright © 2011 John Wiley & Sons, Ltd.

Ultrasound-guided transversalis fascia plane block provides analgesia for anterior iliac crest bone graft harvesting

Abstract: To the Editor, The iliac crest is primarily innervated by the L1 nerve root via the iliohypogastric and ilioinguinal nerves. We describe our preliminary experience with a transversalis fascia plane (TFP) block, which targets these nerves in the plane between the transversus abdominis (TA) aponeurosis or muscle and the deeper transversalis fascia. It can thus provide effective analgesia for anterior iliac crest bone graft (ICBG) harvesting. This technique is distinct from the transversus abdominis plane block, which does not reliably block the L1 dermatome, although its use has been described in ICBG harvesting. Following Ethics Board approval, we reviewed the records of 27 adult patients who underwent harvesting of an anterior ICBG as part of surgery on the distal forearm and wrist between November 1, 2009 and February 28, 2011 at the Toronto Western Hospital. All patients underwent general anesthesia preceded by a single-shot brachial plexus block with 30–40 mL of local anesthetic (1:1 mixture of 2% lidocaine and 0.5% bupivacaine, with epinephrine 2.5 lg mL). Twelve (44%) patients also underwent an ultrasound-guided TFP block. The ultrasound probe was placed in a transverse orientation above the iliac crest; and the external oblique, internal oblique (IO), and TA muscles were identified and traced posteriorly until first the TA muscle and then the IO muscle tapered into their common aponeurosis, adjacent to the quadratus lumborum muscle (Figure, A). The tip of a 22-gauge 80-mm block needle was positioned just deep to the TA muscle and its aponeurosis at the point where the TA tapered off. Ropivacaine 0.5% (20 mL) with epinephrine 5 lg mL was injected into the plane between the TA and underlying transversalis fascia (Figure, B). Intraoperative and postoperative analgesia of the ICBG harvest site was provided by systemic opioids at the discretion of the operating theatre and postanesthesia care unit (PACU) staff. We extracted data on opioid consumption and pain scores during the immediate perioperative period, defined as the time at which the patient entered the operating room to the time the patient left the PACU. We converted all opioid doses into intravenous morphine equivalents and divided patients into two groups for comparison based on whether they had undergone a TFP block. The mean (standard deviation) perioperative opioid dose was substantially lower in the patients who underwent a TFP block [18.5 (9.6) mg of intravenous morphine equivalent] than in those who did not [32.6 (12.4) mg] (P = 0.006). These patients received less intravenous morphine during both the intraoperative period [10.2 (5.6) mg vs 17.4 (6.6) mg; P = 0.009] and the PACU period [8.3 (9.6) mg vs 15.1 (11.2) mg; P = 0.114]. It is of note that only one (8%) patient received intravenous ketorolac 30 mg in the TFP group compared with five (33%) patients in the other group. Patients who underwent a TFP block also had lower resting pain scores in the PACU. Pain scores (median [range]) were lower in the TFP group both at admission to the PACU (2 [0–6] vs 6 [5–7]; P = 0.015) as K. J. Chin, MBBS (&) V. Chan, MD M. Harris, MB BChir Toronto Western Hospital, University of Toronto, Toronto, ON, Canada

Anterior Decompression and Nonstructural Bone Grafting and Posterior Fixation for Cervical Facet Dislocation With Traumatic Disc Herniation

Abstract: Study design A series study of patients with lower cervical facet dislocation accompanied by traumatic disc herniation treated with anterior decompression and nonstructural bone grafting and posterior fixation. Objective To describe a surgical technique of anterior decompression and nonstructural bone grafting and posterior fixation and its clinical outcome in a group of patients with lower cervical facet dislocation accompanied by traumatic disc herniation. Summary of background data The optimal treatment for lower cervical facet dislocation with a prolapsed disc is still controversial. Methods After discectomy and endplate preparation, a layer of morselized cancellous bone grafts from the iliac crest was placed in the interspace, and held in appropriate sagittal position by 2 layers of gelatin sponge and carefully sutured longus colli muscle. The anterior wound was then closed. The posterior elements were exposed and the reduction was performed. Fluoroscopy was used during reduction maneuver to ensure that the graft was still in the appropriate position. A posterior fusion was performed and the posterior wound was closed. Results Between January 2006 and February 2010, 21 patients with cervical facet dislocation accompanied by traumatic disc herniation (13 unilateral dislocations and 8 bilateral dislocations) were recruited for this study. All the patients completed at least 1-year follow-up. Average follow-up duration was 29 ± 3.5 months. Average Frankel scales were significantly improved at the end of follow-up, visual analogue scale decreased from 7.8 ± 1.2 before the operation to less than 1.6 ± 0.5 (P 0.05) 1 year later. The average subsidence of bone graft was 1.28 ± 0.16 mm at 12 months after the operation and remained 1.34 ± 0.20 mm at 36 months after the operation. All patients had consolidation of both anterior and posterior fusions. No cases of instrument failure occurred and no complications were attributed to the use of this technique. Conclusion Although further study based on injury types as well as long-term follow-up is still needed, anterior decompression and nonstructural bone grafting and posterior fixation provides a promising surgical option for treating cervical facet dislocation with traumatic disc herniation.

Iliac flap versus fibula flap in mandibular reconstruction.

Abstract: The mandible is one of the important parts of the body in terms of facial appearance and function. Vascularized free bone grafts have become the criterion standard in mandible reconstruction. With flap survival rates not too much distant to 100%, the focus is now on function and aesthetics. With the various free-flap options now available, reconstruction of the mandibular defect has achieved significant improvement in both functional and aesthetic results. However, few studies have compared the results of these options. The fibula is defined as the most popular flap in mandibular reconstruction, and only in few papers iliac flaps are preferred. However, quality of life and effectiveness data are not available to support this choice. Not any previous study prospectively compared these 2 flaps. Short- and long-term results of an outcome-research study were prospectively compared in microvascular mandibular reconstruction with fibular flap and iliac crest flaps. Mean functional and quality-of-life scores were higher following iliac crest reconstructions. Fibular flap was the flap of choice in total/subtotal mandibulectomy, but it does not appear preferable in hemimandibulectomy and/or in cases of segmental mandibulectomy, if compared with the iliac crest.

Clinical Evaluation of Mineralized Collagen as a Bone Graft Substitute for Anterior Cervical Intersomatic Fusion

Abstract: Although autograft is a routine procedure in anterior interbody fusion of the cervical spine, donor site morbidity is a significant problem. Many bone grafting materials developed such as allograft bone, demineralized bone matrix (DBM), and synthetic implants were used to repair bony defects; however, each has its specific disadvantage. Therefore, alternative materials for autogenous bone in grafting are needed. Ninety-one patients with symptomatic cervical disc diseases were randomly allocated for either autologous iliac crest bone graft (AIG) or mineralized collagen (MC). Clinical and radiological comparisons were performed for the two groups. Patients were followed-up routinely in the outpatient clinic, where clinical and radiological evaluations were taken. The mean operation time to perform AIG and MC was 194 ± 37 and 121 ± 26 minutes, respectively. The mean volume of blood loss during the operation was 140 ± 41 and 79 ± 25 mL for AIG and MC, respectively. The mean length of hospitalization due to AIG and MC was 97 ± 07 and 59 ± 08 days, respectively. The clinical outcomes were identical, and fusion rates were similar between the two groups. This study shows effective results of MC in anterior cervical intersomatic fusion. MC may be a promising substitute for autologous iliac crest bone graft.

Surgical devices and methods providing sacroiliac stabilization

Abstract: A surgical method is for at least one ilium having an iliac crest and inner and outer tables on opposing sides of the iliac crest. The method may include inserting at least one base into the ilium, where the at least one base has a channel therein. The method may further include inserting a support member through the ilium and through the channel of the at least one base so that the support member extends between the inner and outer tables, and securing the support member to the at least one base.