Bone taken from a patient’s hip (autograft) is considered the gold standard in terms of bone graft. It possesses three properties that help to promote bony fusion. It provides a bony architecture where bone can grow, it possesses precursor cells that can form into bone cells, and it contains proteins that stimulate cells to make bone. In contrast, donor bone only provides a bony scaffold where bone can grow. It is often combined with local bone taken from the spine or synthetic factors to give it the elements needed to successfully enhance fusion. The advantage of using donor bone is that it avoids the risks associated with harvesting bone from the hip, such as pain and bleeding.
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Bone taken from your hip is your bone. It's full of living cells and so it's a living piece of material. If you take bone from another person, or a cadaver it's pretty much a dead piece of bone, it's been carefully treated so that the risk of disease transmission is much less. But, because it is not your own bone and because it does not contain living cells it is not as good.
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Putting the issues of risks of each aside (which is covered below), the main difference between your own bone and banked bone is that yours is "alive". There are still living cells and other factors inside the bone when it is moved from one site in your body to the spine. These cells and factors are felt to encourage bone growth. This process is called osteoinduction ("inducing" bone growth). Both your own bone and the bank bone (cadaver bone) act as a frame or lattice for bone to grow across between spinal bones. This process is called osteoconduction ("conduct" bone growth).
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Bone from your own hip offers the highest chance of solid fusion in most instances. Bone from a cadaver donor also will heal but not at as high a rate except in special circumstances.
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Bone taken from your hip appears to be more compatible immunologically with your system than donor bone. Unfortunately, obtaining the hip or iliac-crest bone graft has some complications, including infection, hematomas, pain, and fractures through the bone. With donor bone, these complications are avoided, but the bone can potentially contain some transmittable diseases. Reabsorption of the donor bone as a result of incompatibility or antigenic properties of the bone is also a potential risk factor.
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Generally speaking, using your own bone has the advantage of having a very high fusion rate. Donor bone is sterilized and has no bone-forming substances or bone cells left in it. It, therefore, has a higher risk of fusion failure. It also may take longer to achieve a solid fusion with donor bone as compared to your own bone. Donor bone also carries an extremely small, perhaps only theoretical, risk of disease transmission. The advantages of donor bone include avoiding an additional site of surgery with all of the risks and discomfort that go along with it, reduced surgery time, and reduced surgical expense.
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The bone taken from the patient's hip has a higher fusion rate than donor bone.
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The bone taken from your hip has more active protein that stimulates bone growth. That is the primary difference.
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Bone taken from your own hip tends to improve the fusion rate but also causes increased pain in your hip. Cadaver bone carries a small risk of infection and is not as successful in creating fusion compared to your own bone.
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Obviously, the bone taken from your own pelvis is your own bone. It probably has a higher fusion rate compared with donor bone. Bone from the bone bank, or donor bone, is bone that has been cleaned, processed and sterilized from a cadaver and is specifically sized for a specific application. There is a small risk of disease transmission although on a practical basis it is extremely rare because bone is easy to sterilize. The benefit of using donor bone is that it there is no pain from another incision site and in many applications achieves the same clinical result as your own bone.
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There are many biologic differences, but probably the most important factor is the hip bone harbors living cells that can be turned on to make bone. Donor bone needs a blood supply to bring living cells into the fusion bed to be turned on by the donor bone to create bone.
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Your own bone is usually the best bone but often times donor bone, particularly with instrumentation, is sufficient to give good healing.
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A person’s own bone fragments contain live bone forming cells. Though less reliable in achieving fusion, bone can also be used from a bone bank. This type of bone does not have any live cells capable of creating new bone. Instead, it forms a framework into which new bone can grow.
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Typically, there is slightly higher chance of fusion with somebody's own bone.
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Bone taken from the hip is the patient's own bone whereas donor bone, or allograft bone, is from another human being. This bone is typically radiated and freeze dried and is quite safe in terms of disease transmission. In addition, this bone is not rejected by the person since your body does not recognize it as a foreign substance. The healing rates are not nearly as good with donor bone as it is with the patient's own bone. To make up this difference researchers have developed bone morphogenic proteins.
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The bone from your own hip will not be rejected by your body since it is yours and in addition to the structural bone it contains live cells that allow faster and better healing. Cadaver donor bone is no longer alive, so it contains no cells, and there is the possibility that there could be some rejection.
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In most cases the bone taken from you has better growth potential than donor bone.
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The commentary above recounts the experiences of these physicians. Medtronic invited them to share their stories candidly. Keep in mind that results vary; not every patient's response is the same. Talk with your doctor to learn more about any products that are mentioned above.
It is important that you discuss the potential risks, complications and benefits of spinal surgery with your doctor prior to receiving treatment, and that you rely on your doctor's judgment. Only your doctor can determine whether you are a suitable candidate for this treatment.
