Posterior Iliac Crest Bone Graft

The borders of the posterior ilium are the iliac crest superiorly, the posterior superior iliac spine (PSIS) posteriorly, and the greater sciatic notch inferiorly. The bone is slightly concave on its lateral surface with three distinct ridges comprising the posterior, anterior, and inferior gluteal lines. Harvesting from the posterior iliac region can be performed with the patient positioned either prone or in the lateral position. After exposure of the grafting site, an incision is made through the lateral rim of the cortex of the iliac crest using osteotomies. When performing posterior iliac crest bone-grafting procedures in the prone position, care is taken to appropriately cushion the patient to prevent pressure ulcerations and to provide adequate space for respiratory function. In patients with symptomatic sacroiliac joints, the graft harvest should be performed on the symptomatic side to avoid iatrogenic injury to the asymptomatic joint.