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Posterior Approach for Debridement of the Psoas Abscess
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Anatomic considerations for posterior iliac crest bone procurement.

Somsak Sittitavornwong1, D Scott Falconer, Rakesh Shah

  • 1Assistant Professor, Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, AL.

Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons
|April 30, 2013
PubMed
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This study reveals superior cluneal nerves, sciatic notch, and gluteal vessels are closer to the posterior superior iliac spine (PSIS) than previously thought. Understanding these precise anatomic locations is crucial for safer posterior iliac crest bone graft procurement.

Area of Science:

  • Anatomy
  • Surgical Procedures
  • Orthopedics

Background:

  • Posterior iliac crest bone grafts are a common orthopedic procedure.
  • Potential complications during graft procurement include injury to nearby vital structures.
  • Accurate knowledge of local anatomy is essential for minimizing surgical risks.

Purpose of the Study:

  • To determine the precise anatomic relationships of vital structures to the posterior superior iliac spine (PSIS).
  • To identify structures at risk during posterior iliac crest bone graft harvesting.
  • To provide data for improving surgical safety in this procedure.

Main Methods:

  • Dissection of 39 posterior ilia from 21 cadavers.
  • Utilized the posterior superior iliac spine (PSIS) as the primary anatomical reference.

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  • Measured distances from the PSIS to superior cluneal nerves, middle cluneal nerves, sciatic notch, and superior gluteal vessels.

    • Main Results:

    • Average distances from PSIS: superior cluneal nerves (5.7 cm), middle cluneal nerves (6.55 cm), greater sciatic notch (5.3 cm), and superior gluteal vessels (5.4 cm).
    • The medial superior cluneal nerve was found within 3.0-6.9 cm of the PSIS in 84.5% of specimens.
    • Variability in nerve proximity necessitates careful surgical consideration.

    Conclusions:

    • The medial superior cluneal nerve, greater sciatic notch, and superior gluteal vessels are frequently closer to the PSIS than previously documented.
    • Enhanced understanding of these anatomic locations can aid surgeons in preventing or reducing complications.
    • This research contributes to safer bone graft procurement techniques.