• Caleb R Lippman, Sean A Salehi, John C Liu, and Stephen L Ondra.
• Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
• Neurosurgery. 2006 Feb 1;58(1 Suppl):ONS-E178; discussion ONS-E178.

Objective And ImportanceFusion between the lumbar spine and sacrum has been used to treat deformity, degenerative disease, trauma, and tumor. These constructs have a higher failure rate when a long construct is designed, in patients with poor bone quality, and in patients with previous irradiation or with significant osteoporosis.Clinical PresentationExtending the construct to the pelvis has been shown to increase the fusion rate of these patients and to reduce the risk of hardware failure before fusion has occurred.InterventionWe extend the constructs with the use of iliac bolts placed within the posterior iliac crests. Placement of these bolts can be challenging after the posterior iliac crest has been harvested for autologous bone in a previous operation.ConclusionThe purpose of this technical note is to describe our salvage technique of iliac bolt placement as an adjunct to lumbar-sacral fusions in a previously harvested iliac crest.

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