Conclusions: bone graft substitutes
for spine fusion
The field of osteobiologics continues to expand
rapidly, and significant advances have been made
in the area of bone graft substitutes. The Food
and Drug Administration has recently approved
a number of new bone graft products and substantial
resources are being invested to continue researching
and testing alternatives.
There is certainly reason to hope that in the
future, bone graft harvesting (bone from the
patient’s own pelvis), as a routine part
of spine fusion surgery may not be necessary.
Because harvesting the patient’s bone is
known to carry inherent risks (such as the risk
of postoperative pain, infection, bleeding, etc…),
a viable substitute for this procedure is desirable.
Presently, the choice of a bone graft substitute
depends on several factors, two of which are
the location of the surgery in the spine (cervical,
thoracic, or lumbar) and whether the spine fusion
is being done on the anterior (front) surface
or the posterior (back) surface, as the fusion
beds in each location are quite different.
Currently, the most popular spinal applications
for allograft structural bone are:
For a posterior lumbar fusion surgery, harvested
iliac crest graft (from the patient’s pelvis)
is still the gold standard. For patients having
this procedure, there are surgical techniques
that allow this bone to be harvested without
unacceptable associated morbidity (unwanted side
effects).
In the near future, patients should look for
further development in the areas of:
By:
Alexander R. Vaccaro, MD
August 15, 2003 |
