What's a Bone Graft and Do I Have Any Options?
There are more than 200,000 spinal fusion surgeries performed each year. The most common of this type of surgery is done in the lower back. Spinal fusions involve adding bone graft to an area of the spine between two vertebrae, sometimes on multiple levels of the spine. This addition of a bone graft is the "fusion" part of the surgery.
The goal of a spinal fusion is to decrease back pain by limiting the movement of a certain part of the spine. Though this segment of the spine is kept from moving, most patients do not experience any physical limitations.
The main challenge of a spinal fusion is achieving a "solid fusion." During the healing process the patient's body releases proteins that help to facilitate bone growth. The bone graft a physician implants in a patient's back will need these proteins in order to "fuse" with the two vertebrae surrounding it. When the bone graft and the two vertebrae fuse together into a solid structure, the patient is said to have a "solid fusion."
This process of creating a "solid fusion" is the major challenge for physicians, because every patient is different and will heal or fuse at different rates. Lifestyles, body type and a number of other things factor into the healing process of each individual patient. Also, the type of graft that a physician uses also plays a major role in a patient's recovery.
The most common type of bone graft used in spinal fusion, and currently considered to be the "gold standard," is the iliac crest bone graft, which is a piece of bone taken from the patient's hip. This procedure of taking a graft from a patient's hipbone is separate from the spinal fusion surgery, but is usually done at the same time.
This type of graft is considered to be the gold standard since clinically it has a faster rate of fusion than any other type of bone graft available today. However, 10 to 40% of patients do not achieve a solid fusion when an iliac crest bone graft is used. In patients with multiple levels of the spine fused, the failure rate is even higher.
Many surgeons consider the major problem with iliac crest bone graft to be the increased pain and risk of complications from the additional surgery needed to take the graft from the patient's hip. Often patients with this type of bone graft complain more of intense pain in their hip than of their back after surgery. In addition to the possibility of hip pain, there is also an increased risk of deep tissue infection, hypersensitivity, increased blood loss, increased operating time, increased recovery time and vascular injury when iliac crest bone graft is used. Although this remains the gold standard in bone grafting, there has been significant interest in alternatives to iliac crest bone grafts to eliminate pain and complication risks.
Another bone graft option is processed donor bone. Donor bone, which is taken from a cadaver, is used widely in spinal fusion surgery and is considered the next best option after iliac crest bone graft. However, it takes much longer for a solid fusion to form.
Another bone graft option is Demineralized Bone Matrix (DBM). DBM has been available for many years and is typically used as an extender to a patient graft when insufficient amounts are available. This material is processed from allograft or donor bone and includes proteins from demineralized bone.
Another bone graft option is Bone Morphogenetic Protiens (BMPs). To learn more about BMPs click here.
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