TY - JOUR
T1 - Racial Differences in Iliac Crest Cancellous Bone Composition
T2 - Implications for Preoperative Planning in Spinal Fusion Procedures
AU - Cho, Woojin
AU - Nessim, Adam
AU - Gartenberg, Ariella
AU - Sekerak, Richard
AU - Brill, Sam
AU - Lian, Jayson
AU - Sperling, Karen
AU - Chang, Dong Gune
N1 - Publisher Copyright:
© 2021 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2022/4/1
Y1 - 2022/4/1
N2 - Study Design: This was a retrospective cohort study. Objective: The objective of this study was to determine whether race, specifically American white and American black, correlates with the ratio of cancellous to total bone at the iliac crest. Summary of Background Data: Studies have demonstrated higher proximal femur bone density in American blacks than American whites. However, whether differences occur at the iliac crest, a common site for autologous graft material in spinal fusion surgery, is not well studied. Understanding such differences could aid orthopedic surgeon decision-making regarding graft options. Materials and Methods: A retrospective review was performed on 133 sequential patients ages 18-75 who underwent computed tomography scan of the pelvis, at a single academic medical center from January 1, 2014, to January 1, 2016. The cohort included 46 American white (21 females, 25 males) and 87 American black participants (40 females, 37 males), an average age of 51.8 years. Groups were matched regarding age, sex, body mass index, and Charlson Comorbidity Score. Measurements of cortical and cancellous bone thickness in the right and left iliac crests were performed using bone window protocol on computed tomography scans. Statistical significance was determined using a 2-tailed t test. Results: The interobserver interclass correlation coefficient reliability (N=2) for measurements at the right iliac crest is 0.895 (95% confidence interval, 0.852-0.925), and the interclass correlation coefficient for the left iliac crest is 0.912 (95% confidence interval, 0.877-0.938). A statistically significant difference in the mean cancellous bone ratio was found between American black (0.667±0.065) and American white (0.750±0.051) groups (P<0.001). Conclusions: At the iliac crest, American black patients had a lower mean ratio of cancellous to the total bone as compared with American white patients. This population may benefit from alternative graft options. While iliac crest autograft remains the first option for fusion surgeries, alternative options should be considered to ensure that each patient receives the best-personalized care.
AB - Study Design: This was a retrospective cohort study. Objective: The objective of this study was to determine whether race, specifically American white and American black, correlates with the ratio of cancellous to total bone at the iliac crest. Summary of Background Data: Studies have demonstrated higher proximal femur bone density in American blacks than American whites. However, whether differences occur at the iliac crest, a common site for autologous graft material in spinal fusion surgery, is not well studied. Understanding such differences could aid orthopedic surgeon decision-making regarding graft options. Materials and Methods: A retrospective review was performed on 133 sequential patients ages 18-75 who underwent computed tomography scan of the pelvis, at a single academic medical center from January 1, 2014, to January 1, 2016. The cohort included 46 American white (21 females, 25 males) and 87 American black participants (40 females, 37 males), an average age of 51.8 years. Groups were matched regarding age, sex, body mass index, and Charlson Comorbidity Score. Measurements of cortical and cancellous bone thickness in the right and left iliac crests were performed using bone window protocol on computed tomography scans. Statistical significance was determined using a 2-tailed t test. Results: The interobserver interclass correlation coefficient reliability (N=2) for measurements at the right iliac crest is 0.895 (95% confidence interval, 0.852-0.925), and the interclass correlation coefficient for the left iliac crest is 0.912 (95% confidence interval, 0.877-0.938). A statistically significant difference in the mean cancellous bone ratio was found between American black (0.667±0.065) and American white (0.750±0.051) groups (P<0.001). Conclusions: At the iliac crest, American black patients had a lower mean ratio of cancellous to the total bone as compared with American white patients. This population may benefit from alternative graft options. While iliac crest autograft remains the first option for fusion surgeries, alternative options should be considered to ensure that each patient receives the best-personalized care.
KW - Autologous graft
KW - Bone graft
KW - Bone graft substitutes
KW - Bone harvesting
KW - Iliac crest
KW - Iliac crest autograph
KW - Iliac crest bone graft
KW - Iliac crest donor site
UR - http://www.scopus.com/inward/record.url?scp=85127848250&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85127848250&partnerID=8YFLogxK
U2 - 10.1097/BSD.0000000000001274
DO - 10.1097/BSD.0000000000001274
M3 - Article
C2 - 34907927
AN - SCOPUS:85127848250
SN - 2380-0186
VL - 35
SP - E400-E404
JO - Clinical spine surgery
JF - Clinical spine surgery
IS - 3
ER -