Isolated iliac bone tuberculosis : a case report

Background: Isolated iliac bone tuberculosis is not easy for diagnosis as it can mimic many other conditions. The presentation of our case of isolated iliac bone tuberculosis with special emphasis to imaging findings is justified, by its rarity and not uncommon delay in diagnosis and therapy of such cases. Case Report: A case of isolated iliac bone tuberculosis, initially presented with low back pain and swelling, was unsuccessfully treated for three months before final diagnosis was established. Plain radiography revealed only slight sclerosis of the iliac side of the right sacro-iliac joint. MRI provided more precise and detailed information regarding the site, size and nature of the bony and soft tissue components of the lesion. The bony lesion showed low T1, high T2 signal and marginal enhancement on fat suppressed T1 post-gadolinium images. The soft tissue components also showed post-gadolinium enhancement and abscesses formation. CT scan confirmed the bony lytic lesion and provided guidance for biopsy. Histology confirmed tuberculous nature of the lesion. Conclusions: Imaging presentation of tuberculous osteomyelitis is nonspecific and may mimic many inflammatory and neoplastic conditions. Correlation with the patient's history, immune status, ethnicity, social environment is necessary in narrowing differential diagnosis. This means that iliac tuberculosis, despite its rarity, should be considered as one of diagnostic possibilities, especially in the patients from endemic areas. However, definitive diagnosis is best established with bone needle biopsy

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).

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 without iliac crest autograft. Operative time was higher in the iliac crest bone-graft group (233.4 versus 200.9 minutes; p 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

Incorporation of anterior iliac crest or calvarial bone grafts in reconstructed atrophied maxillae:A randomized clinical trial with histomorphometric and micro-CT analyses

BACKGROUND: Autologous bone grafts have been applied successfully to severely atrophied maxilla via a preimplant procedure. Differences in graft incorporation at the microscopic level can be the decisive factor in the choice between anterior iliac crest and calvarial bone. PURPOSE: To compare conversion of anterior iliac crest bone and calvarial bone 4 months after grafting of the edentulous maxilla. MATERIALS AND METHODS: Twenty consecutive patients were randomly assigned to either anterior iliac crest (n = 10) or calvarial (n = 10) bone harvesting to reconstruct their atrophied maxillae. Biopsies were taken from both fresh bone grafts and reconstructed maxillae after 4 months healing, at time of implant placement. Micro-CT, histomorphometric and histological analyses were performed. RESULTS: Micro-CT analysis revealed that both the anterior iliac crest and calvarial bone grafts retained their volume and bone mass after being incorporated in the maxilla, but with a favor for calvarial bone grafts: calvarial bone grafts had a higher mineral density before and after incorporation. Both bone grafts types were well incorporated after 4 months of healing with preservation of bone volume and mineral density. Although the fresh bone biopsies were similar histomorphometrically, after 4 months of graft incorporation, the osteoid percentage and osteocyte count remained higher in the anterior iliac crest bone whereas the percentage of bone was higher in the calvarial bone grafts compared to the anterior iliac crest bone grafts. CONCLUSIONS: Both donor sites, that is, anterior iliac crest and calvarial bone, are well suited to provide a reliable and stable basis for implant placement 4 months after grafting with mineral density, porosity, and resorption rate in favor of calvarial bone grafts

Donor Site Morbidity of Nonvascularized Bone Graft: A Systematic Review

Objective: To evaluate the donor site morbidity of iliac and fibular nonvascularized bone graft after mandibular resection. Material and Methods:This study was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) in PubMed, Proquest, Science Direct, and Ebsco. A total of 12 studies met the criteria of studies in humans using iliac and fibular nonvascularized bone grafts in mandibular reconstruction after mandibular resection. Results: A greater proportion of patients received iliac nonvascularized bone graft (88.9%) than fibular nonvascularized bone graft (11.1%). Of the 385 cases of iliac bone graft, 153 cases (40%) experienced complications at the iliac donor site, whereas in 48 cases of fibular bone graft, two (4%) experienced complications at the donor site. Hemorrhage, bone fracture, infection requiring debridement, and hematoma were the major complications. Conclusion: The morbidity rate of the nonvascularized bone graft donor site of the fibula (4%) tended to be lower than that of the ilium (40%). Patient age and defect size were not significantly correlated with the occurrence of morbidity donor sites in either the ilium or fibula

The effect of age, anthropometric parameters, vertebral bone densitometry and ash density on iliac crest bone volume and microstructure

Background and Purpose: The purpose was to compare iliac crest bone static bone histomorphometry and vertebral bone densitometry as two methods frequently used in clinical practice. Patients and Methods: Cylindrical bone samples of the iliac crest bone (N=100) for bone histomorphometry and the whole bodies of the third lumbar vertebra (L3) (N=100) for bone densitometry and atomic absorption spectrometry were collected. Multiple regression analyses were carried out and results were considered significant when p<0.05 and 0.01. Results: Age was inversely proportional to all histomorphometric parameters except for Tb.Sp. Age predicted BV/TV with the largest share of contribution of 68%. Gender showed the highest share of contribution for the Tb.Th (32%), while BMD showed it for the Ct.Th (10%). Conclusions: After age and gender, BMD is the third strongest variable to predict iliac crest bone histomorphometric parameters, and thus we can conclude that iliac crest bone histomorphometry and vertebral bone densitometry are correlated, which is important for monitoring osteoporosis in good clinical practic

Can FDG-PET/CT replace blind bone marrow biopsy of the posterior iliac crest in Ewing sarcoma?

OBJECTIVE: To determine and compare the value of (18)F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG-PET/CT) to blind bone marrow biopsy (BMB) of the posterior iliac crest in detecting metastatic bone marrow involvement in newly diagnosed Ewing sarcoma. MATERIALS AND METHODS: This retrospective study included 20 patients with newly diagnosed Ewing sarcoma who underwent pretreatment FDG-PET/CT and a total of 38 blind BMBs (two unilateral and 18 bilateral) of the posterior iliac crest. FDG-PET/CT scans were evaluated for bone marrow involvement, both in the posterior iliac crest and other sites, and compared to blind BMB results. RESULTS: FDG-PET/CT was positive for bone marrow involvement in 7/38 posterior iliac crests, whereas BMB was positive in 5/38 posterior iliac crests. FDG-PET/CT and BMB results in the posterior iliac crest agreed in 36/38 cases (94.7%, 95% confidence interval [CI]: 82.7-98.5%). On a patient level, FDG-PET/CT was positive for bone marrow involvement in 4/20 patients, whereas BMB of the posterior iliac crest was positive in 3/20 patients. On a patient level, FDG-PET/CT and BMB results agreed in 19/20 patients (95.0%, 95% CI: 76.4-99.1%). The only discrepancies between FDG-PET/CT and BMB were observed in two BMBs of one patient. Both BMBs in this patient were negative, whereas FDG-PET/CT indicated bilateral posterior iliac crest involvement and also extensive bone marrow involvement elsewhere. CONCLUSIONS: FDG-PET/CT appears to be a valuable method for metastatic bone marrow assessment in newly diagnosed Ewing sarcoma. The routine use of blind BMB of the posterior iliac crest should be reconsidered when FDG-PET/CT is available

Complications after Use of Iliac Bone Graft for Post Cleft Alveolar Bone Defect

Background: The purpose of the present study was to evaluate the efficacy of the iliac bone graft for secondary alveolar bone grafting in cleft patients and to monitor its complications as a donor site during the last five years, in maxillofacial unit, faculty of medicine, Assiut University, Egypt.Methods: Eighteen cleft patients with secondary alveolar bone grafts using iliac crest bone grafts were included in this study, 10 males and 8 females ranging in ages from 6–22 years. Full history taking, operative details, and follow up to one year postoperatively, early and late postoperative complications reported and analyzed.Results: the iliac bone was reliable as a donor site for bone grafting of the alveolar cleft, the success rate was 11/18, also 5/18 had success from the second interference, the overall complications were acceptable.Conclusions: the anterior iliac crest is one of the best sites for autogenous bone graft for treatment of secondary alveolar cleft; it gives a big volume of highly vascular cancellous bone, with accepted range of postoperative complications

Iliac crest bone graft harvesting complications: A case of liver herniation

SummaryThe iliac crest is an easily accessible donor site offering a relatively large and safe supply of bone. There are however possible complications; residual pain frequently, and more rarely herniation. This latter's true incidence is unknown in a literature review, which found 15 articles. We report a case of liver herniation in a 64-year-old overweight lady after harvesting bone from her iliac crest. The clinical diagnosis was confirmed by CT scan. Despite an appropriate surgical repair, the hernia recurred. This serious complication of bone harvesting from the iliac crest, and possible other undesirable events described, prompted reconsideration of our harvesting techniques, and the use in our unit of bone substitutes or cell therapy to fill bone defects

Use Of The Vascularized Iliac-crest Flap In Musculoskeletal Lesions.

Bone loss was in the past treated by several methods, such as bone distraction and the use of nonvascularized or tissue-bank bone grafts. With the advent of modern microsurgical techniques, the vascularized bone flap has been used with good results; it resolves local nutritional problems, repairs soft tissue that is often damaged by severe trauma, and treats bone loss due to tumors, pseudarthroses, and osteomyelitis. This paper reports the authors' experience with the use of vascularized iliac-crest flaps to treat orthopedic pathologies in five patients with traumatic bone loss (<10 cm), three with osteomyelitis, and three with atrophic nonunion. In all cases, the same surgeon obtained a vascularized iliac-crest flap with a pedicle based on the deep iliac circumflex artery. All flaps consolidated within a mean period of 3 months. These findings demonstrate that the use of an iliac-crest flap is a treatment option in cases of bone loss and that it is associated with good functional results and minimal donor-site morbidity.201323714

Comparative Osteogenesis of Maxilla and Iliac Crest Human Bone Marrow Stromal Cells Attached to Oxidized Titanium - a Pilot Study

Objectives Severe alveolar bone loss affects dental implant placement. Bone augmentation by grafting iliac crest bone rich in osteoprogenitor cells like bone marrow stromal cells (BMSCs) requires a second surgical procedure in non-orofacial bone. Skeletal site-specific osteogenesis indicates maxilla and mandible BMSCs are highly proliferative and exhibit osteogenic properties superior to iliac crest BMSCs. Alveolar bone can be easily obtained during routine dental surgery, but it is unclear if titanium-attached alveolar BMSCs will retain their superior osteogenic properties. This study evaluated and compared in vitro osteogenic properties of titanium-attached maxilla and iliac crest BMSCs in same individuals. Materials and Methods Primary culture of maxilla and iliac crest BMSCs from four normal healthy volunteers were expanded in culture. In 24-well plates, first passage BMSCs were seeded directly (1 × 104 cells/well) on oxidized titanium discs (1.27cm diameter and 2mm thickness) or tissue culture plate. Each cell type was assessed for affinity for titanium, post-attachment survival and osteogenic differentiation based on alkaline phosphatase and osteopontin expressions. Results There was no difference in the affinity of maxilla and iliac crest BMSCs to titanium. However, titanium-attached maxilla BMSCs were apparently more osteogenically responsive than iliac crest cells based on calcium accumulation and gene expression of alkaline phosphatase and osteopontin. But these differences were not statistically significant in this small patient sample. Conclusion Maxilla and iliac crest BMSCs have similar attachment affinity for titanium. This pilot study indicate that titanium-attached maxilla BMSCs were more osteogenically responsive and may be a viable and more readily available donor graft material in implant dentistry