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; Langping Li; Shuai Leng; Christine Hunt; Luke Law; Casey Muir; Jason Eldrige; Mohamad Bydon; Meng Chi; Shane Shapiro; William D. Mauck; Wenchun Qu

doi:10.17305/bjbms.2020.4744

Authors

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

DOI:

https://doi.org/10.17305/bjbms.2020.4744

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.