AN ALTERNATIVE SOURCE OF AUTOGRAFT BONE FOR SPINAL FUSION

Abstract

Autograft bone obtained from the iliac crest remains the "gold standard" for spinal fusion. For various reasons, including previous harvesting or pelvic dysmorphism, the iliac crest bone graft may not be available to the spinal surgeon. We present a novel use of a common orthopedic procedure, intramedullary reaming, for obtaining autograft for revision spinal fusion. A 47-year-old woman presented with failed back syndrome after multiple lumbar surgeries with previous bilateral iliac crest bone harvest. A commercially available reaming system (Synthes Reamer-Irrigator-Aspirator; Synthes USA, West Chester, PA) was introduced into the left intramedullary canal of the femur while the patient remained in the prone position. Using continuous irrigation and aspiration, the reaming debris was collected and used as autograft for the subsequent spinal fusion. The patient underwent a successful L4-L5, L5-S1 transforaminal lumbar interbody fusion with L3-S1 pedicle screw fixation. No complications from the femoral reaming were observed, and 6-month follow-up x-rays demonstrated osseous fusion. Femoral reaming provides an alternative source of autograft bone when other sources are unavailable.