Safe and successful bone marrow biopsy: an anatomical and CT-based cadaver study

Area of Science:

• Orthopedic Surgery
• Anatomy
• Medical Procedures

Background:

• Bone marrow biopsy is a common procedure with rare but serious complications.
• These injuries often result from inadvertent penetration of the iliac bone's inner cortex.
• Current guidelines lack evidence-based needle orientation for iliac crest biopsy.

Purpose of the Study:

• To evaluate an evidence-based approach for needle orientation during iliac crest biopsy.
• To compare the safety and anatomical risks of two needle paths: perpendicular and lateral.

Main Methods:

• Human cadavers were used to study posterior to anterior bone marrow needle paths from the posterior superior iliac spine (PSIS).
• Two orientations were tested: perpendicular to the coronal plane and lateral toward the ipsilateral anterior superior iliac spine (ASIS).
• Dissections and imaging identified the relationship of the needle to internal structures after deliberate inner cortex penetration.

Main Results:

• Both approaches involved initial perpendicular puncture of the outer cortex at the PSIS.
• The lateral approach, reorienting the needle toward the ipsilateral ASIS, demonstrated less damage to neurovascular structures.
• The lateral approach also successfully avoided the sacroiliac joint compared to the perpendicular approach.

Conclusions:

• The lateral approach for bone marrow biopsy from the PSIS is safer than the perpendicular approach.
• This technique minimizes neurovascular damage and sacroiliac joint injury.
• Performing the biopsy in the lateral decubitus position with the lateral approach can prevent reported complications.