Lateral and posterolateral iliac crest approach for bone marrow aspirate harvest in regenerative orthopedic applications.

purposeTo describe and standardize a reproducible posterolateral approach to the posterior iliac crest for bone marrow aspirate (BMA) harvesting, based on a palpation-guided technique with optional ultrasonographic confirmation, emphasizing anatomical accuracy, safety, and procedural simplicity.

methodsThe technique was performed in 63 patients using a Jamshidi-type cannula introduced through a lateral entry point aligned with the posterior superior iliac spine (PSIS). Guided by palpable anatomical landmarks and optionally confirmed by ultrasound, small-volume aspirations (4-5 mL) were performed with systematic needle reorientation to minimize peripheral blood dilution and optimize marrow cell yield. The procedure was conducted under local anesthesia, with the patient positioned laterally to ensure comfort and ergonomic access for the operator, allowing multiple aspirations through a single entry site.

resultsThe posterolateral PSIS approach, using a palpation-based method with optional ultrasonographic confirmation, was feasible and anatomically consistent in this descriptive case series of 63 patients. Using predefined anatomical criteria for procedural success, correct subendosteal cannula positioning at the level of the PSIS was achieved in all procedures. In cases in which ultrasonography was employed, correct positioning was sonographically confirmed. When ultrasonographic confirmation was not used, the procedure was completed based on anatomical landmark guidance alone, without any intention of comparative assessment. The lateral patient position offered ergonomic advantages for the operator and enhanced patient comfort, while maintaining a low risk to adjacent neurovascular structures.

conclusionsThis standardized, palpation-guided lateral technique provides a safe, efficient, and anatomically reliable method for bone marrow harvesting that can be performed under local anesthesia in an outpatient or office-based setting. CLINICAL RELEVANCE: By combining anatomical precision with procedural simplicity and eliminating the need for fluoroscopy or continuous ultrasound guidance, this approach facilitates broader access to bone marrow aspiration for orthopedic and regenerative applications, enhancing both procedural efficiency and patient experience.