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W B Rodgers, MD
Step 4. Direct the needle dorsally, caudally, and medially. Studies have shown that only the first 2 cc of aspirate contains viable osteogenic precursor cells.' Therefore, do not aspirate more than 2 cc prior to redirecting the needle.
1. Muschler GF. Boehm C. Easley K. Aspiration to obtain osteoblast progenitor cells from human bone marrow: the influence of aspiration volume. J Bone Joint Surg Am. 1997: 79: 1699-1709.…
Step 1 . Prepare and drape the site as for iliac crest graft harvest. With a surgical marker, outline the medial and lateral borders of the anterior crest and the anterior superior iliac spine. Note that the iliac crest curves dorsally toward the sacroiliac joint. Also note that the lateral anterior crest has a significant overhanging lip.
Step 2. Introduce the aspiration needle into the crest. The entry point must be in the central-medial portion of the crest to avoid penetrating the lateral overhanging lip. Note that the inner and outer tables of the pelvis converge below the anterior crest. Gentle manipulation is necessary to direct the needle between the tables. Take care to stay within the tables of the pelvis. Too much angulation may perforate the medial wall of the pelvis and place the abdominal viscera at risk. Or, it may violate the lateral pelvic wall and enter the gluteal musculature, potentially damaging the lateral femoral cutaneous nerve. The sciatic nerve can also be entered inferiorly, endangering the sciatic nerve and the superior gluteal artery.
Step 3. Remove the trocar and aspirate the bone marrow.
1. Muschler GF. Boehm C. Easley K. Aspiration to obtain osteoblast progenitor cells from human bone marrow: the influence of aspiration volume. J Bone Joint Surg Am. 1997: 79: 1699-1709.
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