Posterior Approach to the Iliac Crest

  • The Posterior Approach to the Iliac Crest is used to harvest a bone graft from iliac crest.

  • Place the patient prone on the operating table.

  • Landmarks:

    • Palpate the posterior superior iliac spine
    • posterior part of the iliac crest
  • Incision:

    • Make an 8-cm oblique incision, centered over the posterior superior iliac spine and in line with the iliac crest.

  • The outer border of the iliac crest is truly an internervous plane because muscles insert into or take origin from the iliac crest, but do not cross it.
  • The gluteus medius, minimus, and maximus muscles take their origins from the outer surface of the ilium.
  • The gluteus medius and minimus are supplied by the superior gluteal nerve and the gluteus maximus is supplied by the inferior gluteal nerve.

  • The subcutaneous tissues should be dissected until the iliac crest is reached

  • Strip the musculature completely off the posterior portion of the lateral surface of the ilium so that a large enough graft can be obtained.
  • Proceeding 1.5 cm down the ilium in the area of the posterior superior spine, the elevated posterior gluteal line can be seen and felt.
  • pass subperiosteally up over the line and then down its other side. 

  • The Posterior Approach to the Iliac Crest cannot be extended.
  • It is designed specifically for removing bone for graft material from the posterior outer cortex of the ilium. Inner cortex also may be taken, but soft tissues should not be stripped off the anterior (deep) aspect of the ilium.

  • The structures at risk during Posterior Approach to the Iliac Crest includes:
    • Nerves:

      • Sciatic nerve
    • Vessels:

      • The superior gluteal vessel, a branch of the internal iliac (hypogastric) artery.
    • Bone:

      • Avoid the sciatic notch.

  • Surgical Exposures in Orthopaedics book - 4th Edition
  • Campbel's Operative Orthopaedics book 12th
Posterior Approach to the Iliac Crest Posterior Approach to the Iliac Crest Posterior Approach to the Iliac Crest Posterior Approach to the Iliac Crest
Images Source:
  • Surgical Exposures in Orthopaedics 4th Edition Book.
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