To determine the clinical features of iliac crest graft harvest site fracture after spinal arthrodesis, a retrospective study surveying the spinal surgery performed at Case Western Reserve University was performed. Approximately 200 cervical spine fusions and an equal number of lumbar spine fusions are performed in that center each year. Between November 1985 and March 1991, 14 patients were identified with fractures at an iliac crest graft harvest site. All but 1 of these patients were female. They had an average age at surgery of 61 years old (range, 24-76 years old). Twelve patients had cervical procedures (2 posterior and 10 anterior fusions). The patients with anterior cervical fusions experienced avulsion fractures of the anterior superior iliac spine. One patient with a posterior occipital cervical fusion experienced bilateral posterior iliac wing fractures, and 1 with posterior atlantoaxial fusion resulted in a unilateral iliac wing fracture. All patients were treated nonoperatively with protection of weight bearing until resolution of pain. All patients had satisfactory results at final followup ranging from 6 months to 5 years. Three patients had residual mild pain that did not affect activities of daily living. The remainder were pain free. Few series of fractures of the pelvis after graft harvest are reported. This group of patients had satisfactory results with nonoperative treatment. Older female patients with osteopenic bone are prone to iliac graft site fracture, and particular care should be exercised in this population.