Three Case Reports of Donor Site Iliac Bone Fracture as a Complication of Anterior Cervical Fixation Surgery

Although intervertebral implants have been advocated for cervical fixation surgery, classic Cloward's method or Smith-Robinson's methods using autologous iliac bone has been performed in our clinic for about 30 years. In most cases, the postoperative clinical course is uneventful with satisfactory result. However, the authors experienced three cases of donor site iliac bone fracture in the patients who performed anterior cervical fixation surgery. All three patients were female, elderly, short, and lean with low bone mineral density. Iliac bone fractures manifested with sudden pain in the vicinity of donor site. For the iliac bone fracture, two patients received invasive plate fixation surgery and the other was managed conservatively. As to the mechanism of donor site iliac bone fracture, the share stress during bone donation is speculated to cause iliac crest fragile. After beginning of walking after surgery, tractive force of the muscles attaching to the iliac crest play an important role in promoting the fracture cleft. Several clinical factors were analyzed to investigate the cause and prevention of this troublesome complication of cervical anterior fixation surgery. Age, female gender, lean, and small structure were risk factors for such iliac donor site fracture.