Anatomy of the ilium for bone marrow aspiration: map of sectors and implication for safe trocar placement

Hernigou, Jacques; Alves, Alexandra; Homma, Yashiuro; Guissou, Isaac; Hernigou, Philippe

doi:10.1007/s00264-014-2353-7

Cited by 58 publications

(33 citation statements)

References 9 publications

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“…Whereas overall use has increased, review of the literature reveals very few techniques for iliac crest aspiration, 1 but these are not based on anatomic relationships or studies. Hernigou and colleagues 2,3 attempted to quantitatively evaluate potential "sectors" allowing for safe aspiration using cadaver and computed tomographic reconstruction imaging. We used magnetic resonance imaging (MRI) to analyze aspiration parameters.…”

mentioning

confidence: 99%

“…Owing to the ilium's anatomy, improper positioning or aspiration technique during aspiration can result in serious injury. 2,[4][5][6] We hypothesized that there is an ideal angle and positioning for bone marrow aspiration from the posterior superior iliac spine (PSIS) that is safe, consistent, and reproducible. Although most aspiration techniques use landmark palpation, this is unreliable and inaccurate, especially when compared with ultrasound-guided injections [7][8][9][10][11][12][13][14][15][16] and procedures.…”

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confidence: 99%

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An MRI Analysis of the Pelvis to Determine the Ideal Method for Ultrasound-Guided Bone Marrow Aspiration from the Iliac Crest

Hirahara¹,

Panero

Andersen³

2018

Am J Orthop

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Use of mesenchymal stem cells from bone marrow has gained significant popularity. The iliac crest has been determined to be an effective site for harvesting mesenchymal stem cells. Review of the literature reveals that multiple techniques are used to harvest bone marrow aspirate from the iliac crest, but the descriptions are based on the experience of various authors as opposed to studied anatomy. A safe, reliable, and reproducible method for aspiration has yet to be studied and described. We hypothesized that there would be an ideal angle and distance for aspiration that would be the safest, most consistent, and most reliable. Using magnetic resonance imaging (MRI), we reviewed 26 total lumbar spine MRI scans (13 males, 13 females) and found that an angle of 24° should be used when entering the most medial aspect of the posterior superior iliac spine (PSIS) and that this angle did not differ between the sexes. The distance that the trocar can advance after entry before hitting the anterior ilium wall varied significantly between males and females, being 7.53 cm in males and 6.74 cm in females. In addition, the size of the PSIS table was significantly different between males and females (1.20 cm and 0.96 cm, respectively). No other significant differences in the measurements gathered were found. Using the data gleaned from this study, we developed an aspiration technique. This method uses ultrasound to determine the location of the PSIS and the entry point on the PSIS. This contrasts with most techniques that use landmark palpation, which is known to be unreliable and inaccurate. The described technique for aspiration from the PSIS is safe, reliable, reproducible, and substantiated by data.

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confidence: 99%

mentioning

confidence: 99%

An MRI Analysis of the Pelvis to Determine the Ideal Method for Ultrasound-Guided Bone Marrow Aspiration from the Iliac Crest

Hirahara¹,

Panero

Andersen³

2018

Am J Orthop

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“…Hernigou et al [44] noted only 8 complications in 1800 marrow aspiration procedures, which is reassuring. However, an additional study by Hernigou [47] noted 410 cadaveric trocar entries (parallel in various sectors) with 114 medial or lateral table breaches (28%), which is very concerning. There is a greater risk of complications if the surgeon is inexperienced or the patient is obese (body mass index >30).…”

Section: Bone Marrowmentioning

confidence: 99%

“…This situation is only good if one does not continue to drive the needle further and the position is checked. This technique is different from the aspiration parallel [41] to the iliac wing tables (Figure 6), which increases the risk of neural and vascular injury [44,47‐48].…”

Section: Bone Marrowmentioning

confidence: 99%

Technical Issues in Harvesting and Concentrating Stem Cells (Bone Marrow and Adipose)

Bowen

2015

PM&R

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The area of regenerative medicine, through the use of cell-based or biologic therapies, affords various options even with the choice of autologous stem cells and requires the clinician to use the currently evolving science along with the art of medicine. Potential sources for stem cells are embryos, fetuses, and adults (adipose tissue or adult cells, usually from skin [induced pluripotent], amniotic fluid, cartilage, bone marrow, menstrual blood, peripheral blood, placenta, skin, teeth, synovium, or umbilical cord blood). Issues regarding the source of stem cells include ethical and political/regulatory concerns, cell frequency, ease/difficulty of extraction, ease/difficulty of graft preparation, and host reaction to the implant. The most common sources of stem cells for orthopedic conditions are adipose tissue and bone marrow. Various opinions are expressed within the medical literature for and against both of these stem cell sources. This article will review patient concerns and preparation for obtaining cells; equipment, supplies, and staffing for the procedures; techniques, pearls, pitfalls, and risks of the procedures; and the manner of/options for processing the cells.

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“…Marrow was aspirated under general anesthesia, from the anterior iliac crest as previously described [34,35]. After deep insertion of an aspiration needle of six to eight centimeters long between the two tables of the iliac wing, the marrow was aspirated into a 10-ml plastic syringe.…”

Section: Treatment Proceduresmentioning

confidence: 99%

Local transplantation of bone marrow concentrated granulocytes precursors can cure without antibiotics infected nonunion of polytraumatic patients in absence of bone defect

Hernigou

Trousselier

Roubineau

et al. 2016

International Orthopaedics (SICOT)

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Anatomy of the ilium for bone marrow aspiration: map of sectors and implication for safe trocar placement

Abstract: Using the sector system, trocars can be directed away from neural and vascular structures and towards zones that are likely to contain larger bone marrow stock.

Cited by 58 publications

References 9 publications

An MRI Analysis of the Pelvis to Determine the Ideal Method for Ultrasound-Guided Bone Marrow Aspiration from the Iliac Crest

An MRI Analysis of the Pelvis to Determine the Ideal Method for Ultrasound-Guided Bone Marrow Aspiration from the Iliac Crest

Technical Issues in Harvesting and Concentrating Stem Cells (Bone Marrow and Adipose)

Local transplantation of bone marrow concentrated granulocytes precursors can cure without antibiotics infected nonunion of polytraumatic patients in absence of bone defect

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