Iliac Crest Bone Marrow Aspiration: Fluoroscopic Guidance

Keywords

aspiration, biopsy, BMAC, bone marrow aspirate, flouroscopy, iliac crest, regenerative, stem cells

Note: Please see pages ii , iii for a list of anatomic terms/abbreviations used throughout this book.

A parallel technique between the table of the ilium under fluoroscopic guidance avoids breach and allows for aspiration from multiple sites to maximize yield.

Trajectory View ( Fig. 36A.1 )

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The entry point for the bone marrow aspirate trocar is not more than 10 cm cephalad to the posterior superior iliac spine .

Fig. 36A.1

A, Fluoroscopic image of iliac crest biopsy, trajectory view. B, Radiopaque structures, trajectory view. C, Radiolucent structures, trajectory view.
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The image intensifier is obliqued approximately 40 degrees contralaterally.
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The C-arm is then tilted cranially approximately 35 degrees.
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The ideal “setup view” delineates the medial and lateral tables of the posterior iliac crest.
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In the trajectory view, the needle should be placed parallel to the fluoroscopic beam.
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Once the trocar penetrates the cortical bone, the sharp tip of the stylet can be exchanged with a blunt tip.
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Other multiplanar imaging views should also be utilized for needle advancement.
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The needle is advanced 4 to 8 cm between the medial and lateral tables of the ilium.