A pedicle bone grafting procedure for failed lumbosacral spinal fusion

An iliac crest bone graft with an intact quadratus lumborum muscle pedicle was devised for the surgical repair of symptomatic pseudarthroses in failed lumbosacral spinal fusions. The graft and pedicle are rotated into a paraspinous bed and internally fixed to the spine. The preliminary results are presented in 12 patients in whom operations were performed under the direction of a single surgeon. The follow-up periods averaged 39 months (range, 8-68 months). Eleven patients demonstrate radiologic evidence of union, and nine subjectively report improvement of symptoms. Five complications occurred in four patients. Two superficial infections quickly resolved with appropriate therapy. One patient had neural foraminal encroachment from an internal fixation device, necessitating its early removal. In a fourth patient major complications of a deep infection and an incisional hernia were successfully treated. Iliac pedicle grafting is an alternative stabilization procedure for use in a select group of patients with disabling pain and previous failed spinal fusion.