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Review
. 2008 Nov;3 Suppl 3(Suppl 3):S164-9.
doi: 10.2215/CJN.00460107.

Technical approach to iliac crest biopsy

Joel D Hernandez  1 , Katherine Wesseling, Renata Pereira, Barbara Gales, Rick Harrison, Isidro B Salusky
Affiliations
Review

Technical approach to iliac crest biopsy

Joel D Hernandez et al. Clin J Am Soc Nephrol. 2008 Nov.

Abstract

Bone histomorphometry has been the gold standard in the evaluation and diagnosis of renal osteodystrophy. The recent new definition of renal osteodystrophy as chronic kidney disease-mineral and bone disorder has once again highlighted the use of bone biopsy as a powerful and diagnostic tool to determine skeletal abnormalities in chronic kidney disease. The procedure of iliac crest bone biopsy has been proved safe and associated with very minimal morbidity. In this review, the clinical indications, preparation, instrumentation, and potential complications are discussed. Because current biochemical markers are poor predictors of bone turnover, volume, and mineralization, a wider use of bone biopsy and histomorphometry will lead to a better understanding of the bone and mineral disorders that are associated with chronic kidney disease.

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Figures

Figure 1.
Figure 1.
Tetracycline double labeling on bone-osteoid surface as seen in fluorescent light.
Figure 2.
Figure 2.
Electric drill for horizontal and vertical iliac crest biopsies.
Figure 3.
Figure 3.
Modified Bordier trephine, from top to bottom, includes a pointed trochar, an outer guide or sleeve, a trephine, and a blunt extractor.
Figure 4.
Figure 4.
The biopsy site is identified 2 cm posterior to anterior iliac crest (dotted line outlines the iliac crest).
Figure 5.
Figure 5.
Lidocaine (10%) is used to anesthetize skin, subcutaneous tissue, and periosteum.
Figure 6.
Figure 6.
After an incision is made, the muscle and fascia are separated by blunt dissection until the periosteum is exposed.
Figure 7.
Figure 7.
The pointed obturator together with the outer guide is inserted and applied firmly to the exposed bone. The guide is rotated and implanted on the lateral ilium.
Figure 8.
Figure 8.
The trephine is inserted into the outer guide and rotated counterclockwise with steady pressure until the cutting action of the trephine on the bone is felt.
Figure 9.
Figure 9.
Trephine advancing through the full length of the iliac crest.
See this image and copyright information in PMC

References

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