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POSTERIOR APPROACH TO THE ILIAC CREST

USES

This approach is most commonly used to obtain bone graft, usually for posterior spinal fusions.

ADVANTAGES

Because patients are already in the prone position for posterior spinal fusion, the posterior iliac crest is conveniently accessible. If a long lumbar incision is planned, the approach can be done through the same incision by subcutaneously elevating the soft tissues laterally to the iliac crest. Also, compared to the anterior iliac crest, a greater volume of bone graft is available posteriorly.

DISADVANTAGES

One possible disadvantage is patient discomfort to the surgical site, particularly when lying supine.

STRUCTURES AT RISK

The sciatic nerve and superior gluteal artery are at risk if the dissection is taken close to or beyond the sciatic notch. To avoid these structures, the dissection is kept subperiosteal and cephalad to the sciatic notch. The clunial nerves also cross the posterior iliac crest and are at risk for causing painful neuromas if injured. If the incision is kept less than 8 cm lateral to the posterior superior iliac spine, the nerves are protected.

TECHNIQUE

Related posts:

Volar Approach to the Basal Joint of the Thumb (for Bennett’s Fracture) Paronychium Approach Anterior Approach Anterolateral (Internervous) Approach Posterior Approach Anterior Approach to the Cervical Spine

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