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5833
A Novel Fluoroscopic Approach Utilized for Bone Marrow Aspiration to Obtain Mesenchymal Stem Cells for Regenerative Medicine
Session: MP-06a
Fri, Nov 16, 10:30 am-12:15 pm
Cibolo 4

Please note, medically challenging cases are removed three months after the meeting and scientific abstracts after three years.

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Introduction

Mesenchymal stem cells (MSCs) are an important cornerstone in regenerative medicine and may impede the degenerative process and provide pain control.[1, 2] Bone marrow aspiration (BMA) is a common procedure utilized to harvest MSCs. The traditional BMA technique through the iliac crest is potentially unsafe due to the vicinity of neurovascular structures in the greater sciatic notch.[3, 4] A new BMA technique, specifically a needle trajectory from the posterior superior iliac spine (PSIS) to the anterior inferior iliac spine (AIIS), was developed utilizing a fluoroscopically-guided approach displaying a ‘tear-drop merging’ view. The objective of our study was to utilize three-dimensional (3D) reconstructed computed tomography (CT) images of the pelvis and sacrum to validate that this novel approach allows safe access to the bony cortex offering optimal BMA yield and a wide safety margin from the greater sciatic notch.

Materials and methods

A retrospective chart review of 260 patients was conducted, analyzing 3D reconstructed CT images of the pelvis and sacrum. This review was approved by the Mayo Clinic Institutional Review Board. Distances between the greater sciatic notch and either a needle trajectory from the PSIS to AIIS (novel approach) or a needle trajectory from the PSIS to greater trochanter (traditional approach) were measured. The degree of cephalad angulation and contralateral obliquity were also assessed. Aspirate quality for the novel approach was determined by calculating the area of bone marrow encountered with the needle trajectory.

Results/Case report

Utilizing the novel BMA approach, the shortest distance between the greater sciatic notch and a needle trajectory between the PSIS and AIIS was 1.91 ± 0.35 cm on the left side and 1.89 ± 0.31 cm on the right side. None of these cases crossed the greater sciatic notch. The degree of cephalad angulation was 25.29° ± 4.34° on the left side and 24.93° ± 4.15° on the right side, and the degree of contralateral obliquity was 24.58° ± 4.99° on the left side and 24.56° ± 4.67° on the right side. The area of bone marrow encountered with the novel approach was 22.53 ± 2.50 cm2 on the left side and 22.66 ± 2.42 cm2 on the right side. Utilizing the traditional approach, the needle trajectory crossed the greater sciatic notch in all cases, and the distance between the greater sciatic notch boundary and a needle trajectory from the PSIS to the greater trochanter was 1.76 ± 0.48 cm on the left side and 1.74 ± 0.47 cm on the right side. The degree of cephalad angulation was 43.43° ± 3.44° on the left side and 43.36° ± 3.33° on the right side, and the degree of contralateral obliquity was 49.82° ± 5.07° on the left side and 49.36° ± 4.56° on the right side.

Discussion

A novel needle trajectory from the PSIS to the AIIS for BMA utilizing the ‘tear-drop merging’ view offers a wide safety margin from the greater sciatic notch and an optimal aspirate yield, with the needle trajectory entering the PSIS at approximately 20-30° cephalad from the transverse plane and 20-30° lateral from the mid-sagittal plane.

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