A three-dimensional computed tomography study to determine the ideal method for fluoroscopically-guided bone marrow aspiration from the iliac crest

  • Ryan S. D'Souza Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA https://orcid.org/0000-0002-4601-9837
  • Langping Li Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA; Department of Anesthesiology, Ruijin Hospital, Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China https://orcid.org/0000-0003-0289-5787
  • Shuai Leng Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
  • Christine Hunt Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA https://orcid.org/0000-0002-0507-7889
  • Luke Law Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
  • Casey Muir Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA https://orcid.org/0000-0002-0045-2387
  • Jason Eldrige Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA; Department of Pain Medicine, Mayo Clinic, Rochester, Minnesota, USA https://orcid.org/0000-0003-0250-6024
  • Mohamad Bydon Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA https://orcid.org/0000-0002-0543-396X
  • Meng Chi Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
  • Shane Shapiro Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA https://orcid.org/0000-0001-5753-0625
  • William D. Mauck Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA; Department of Pain Medicine, Mayo Clinic, Rochester, Minnesota, USA https://orcid.org/0000-0003-0704-181X
  • Wenchun Qu Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA; Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA; Department of Pain Medicine, Mayo Clinic, Rochester, Minnesota, USA https://orcid.org/0000-0003-2402-8318
Keywords: Mesenchymal stem cells, bone marrow aspirate, regenerative medicine

Abstract

Bone marrow aspiration (BMA) through the iliac crest is potentially unsafe due to the vicinity of neurovascular structures in the greater sciatic notch. Our objective was to investigate the safety of a recently described BMA technique, specifically a trajectory from the posterior superior iliac spine (PSIS) to the anterior inferior iliac spine (AIIS). We conducted a chart review of 260 patients, analyzing three-dimensional reconstructed computed tomography images of the pelvis and sacrum to validate that this new approach offers a wide safety margin from the greater sciatic notch. Analysis of three-dimensional computed tomography scans demonstrated that the PSIS to AIIS trajectory never crossed the greater sciatic notch. The trajectory was noted to be at least one cm away from the greater sciatic notch in all measurements. The new trajectory entered the PSIS at 25.29 ± 4.34° (left side) and 24.93 ± 4.15° (right side) cephalad from the transverse plane, and 24.58 ± 4.99° (left side) and 24.56 ± 4.67° (right side) lateral from the mid-sagittal plane. The area of bone marrow encountered with the new approach was approximately 22.5 cm2. Utilizing the same CT scans, the trajectory from the traditional approach crossed the greater sciatic notch in all scans, highlighting the potential for violating the greater sciatic notch boundary and damaging important neurovascular structures. Statistically significant sex-related differences were identified in needle trajectory angles for both approaches. We conclude that based on this three-dimensional computed tomography study, a trajectory from the PSIS to the AIIS for BMA may offer a wide safety margin from the greater sciatic notch.

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A three-dimensional computed tomography study to determine the ideal method for fluoroscopically-guided bone marrow aspiration from the iliac crest
Published
2020-05-11
How to Cite
1.
D’Souza RS, Li L, Leng S, Hunt C, Law L, Muir C, Eldrige J, Bydon M, Chi M, Shapiro S, Mauck WD, Qu W. A three-dimensional computed tomography study to determine the ideal method for fluoroscopically-guided bone marrow aspiration from the iliac crest. Bosn J of Basic Med Sci [Internet]. 2020May11 [cited 2020Aug.7];. Available from: https://www.bjbms.org/ojs/index.php/bjbms/article/view/4744
Section
New and Emerging Methods