Incidental neoplasm in iliac crest autograft procured for anterior cervical fusion

A case report is presented.

To present a previously unreported complication of procuring anterior iliac crest autograft.

Many complications that involve the common procedure of procuring iliac crest autograft have been reported and studied. The incidental finding of a neoplasm in an iliac crest autograft in an otherwise asymptomatic patient has not been reported previously.

A case of benign fibrous histiocytoma is presented as it was found incidentally during the procurement of the anterior iliac crest for anterior cervical fusion. Intraoperative decision making and alternatives for this challenging situation are reviewed.

An iliac crest bone graft with a grossly unusual appearance was noted at the time of autograft procurement. The autograft was aborted, and an iliac crest allograft was substituted for the autograft to complete the planned cervical fusion. The lesion was later identified histopathologically and clinically as a benign fibrous histiocytoma. Postoperative computed tomography demonstrated the extent of the lesion.

The intraoperative finding of a bony neoplasm at a planned autograft donor site in an otherwise healthy patient supports routine preoperative discussion of allograft alternatives. All patients undergoing surgery in which autograft is to be used should be informed regarding the possibility of allograft substitution. When a neoplasm is encountered unexpectedly, oncologic principles of obtaining frozen section or a touch-prep for diagnosis, avoiding the use of suspect graft material as well as cross-contamination of iliac crest and anterior cervical surgical sites, should be applied. Care should be taken intraoperatively with potentially contaminated drapes and instruments.