Superior gluteal artery injury during iliac bone grafting for spinal fusion - A case report and literature review

Study Design. This article reports a complication encountered when harvesting bone graft from the posterior iliac crest during a contemplated spinal fusion. Objectives. Posterior iliac crest bone grafting is commonly performed with posterior spinal instrumentation and fusion. Summary of Background Data. Review of the literature reveals a few case reports of damage through the superior gluteal artery during harvesting of bone grafts; this complication is managed with direct vessel ligation. Methods. This article reviews the pertinent anatomy of posterior iliac crest bone grafting and addresses areas of caution important in preventing this complication. Results. The case report offers alternative management, that is, selective arterial embolization for hemodynamic control of the massive life-threatening bleeding that can occur with superior gluteal artery lacerations. Conclusions. Injury to the superior gluteal artery is a common complication in pelvic trauma. In this patient, therapeutic arterial embolization proved to be a useful tool in controlling hemorrhage, which prevents additional bleeding problems. Superior gluteal artery injury after elective bone graft surgery is a relatively uncommon, serious, but avoidable complication. In this patient, the use of radiographically controlled arterial embolization of the lacerated vessel proved to be a quick and effective solution to this potentially life-threatening complication.