Vulnerability of the subcostal nerve to injury during bone graft harvesting from the iliac crest.
OBJECTIVE
Autologous bone graft harvesting from the iliac crest remains the gold standard for fusion surgery. One disadvantage of autologous bone harvesting is the patient's enduring postoperative pain at the donor site. Nerve injury is one of the postulated mechanisms that may account for this pain. The object of this study was to determine whether the lateral cutaneous branch of the subcostal nerve is vulnerable to injury in the process of obtaining grafts from the anterior iliac crest.


METHODS
Anatomical dissections were performed on 10 cadaveric specimens to ascertain the size of the T-12 subcostal nerve and its position in relation to the iliac crest.


CONCLUSIONS
The lateral cutaneous branch of the subcostal nerve may lie as close as 6 cm from the anterior superior iliac spine. This nerve is very vulnerable to injury when harvesting bone from the anterior iliac crest. Knowledge of the anatomy may decrease the risk of injury to this nerve.
Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Dean
D
Chou
Phillip B
PB
Storm
James N
JN
Campbell
D000005:Abdomen / Q000294:innervation; D016025:Bone Transplantation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007085:Ilium / Q000637:transplantation*; D007431:Intraoperative Complications; D008297:Male; D012867:Skin / Q000294:innervation; D013127:Spinal Nerves / Q000033:anatomy & histology / Q000293:injuries* / Q000601:surgery*; D013904:Thoracic Vertebrae