Bone grafting alternatives in spinal surgery.
BACKGROUND
Bone grafting is used to augment bone healing and provide stability after spinal surgery. Autologous bone graft is limited in quantity and unfortunately associated with increased surgical time and donor-site morbidity. Alternatives to bone grafting in spinal surgery include the use of allografts, osteoinductive growth factors such as bone morphogenetic proteins and various synthetic osteoconductive carriers.


OBJECTIVE
Recent research has provided insight into methods that may modulate the bone healing process at the cellular level in addition to reversing the effects of symptomatic disc degeneration, which is a potentially disabling condition, managed frequently with various fusion procedures. With many adjuncts and alternatives available for use in spinal surgery, a concise review of the current bone grafting alternatives in spinal surgery is necessary.


METHODS
A systematic review of the contemporary English literature on bone grafting in spinal surgery, including abstract information presented at national meetings.


METHODS
Bone grafting alternatives were reviewed as to their efficacy in extending or replacing autologous bone graft sources in spinal applications.


RESULTS
Alternatives to autologous bone graft include allograft bone, demineralized bone matrix, recombinant growth factors and synthetic implants. Each of these alternatives could possibly be combined with autologous bone marrow or various growth factors. Although none of the presently available substitutes provides all three of the fundamental properties of autograft bone (osteogenicity, osteoconductivity and osteoinductivity), there are a number of situations in which they have proven clinically useful.


CONCLUSIONS
Alternatives to autogenous bone grafting find their greatest appeal when autograft bone is limited in supply or when acceptable rates of fusion may be achieved with these substitutes (or extenders) despite the absence of one or more of the properties of autologous bone graft. In these clinical situations, the morbidity of autograft harvest is reasonably avoided. Future research may discover that combinations of materials may cumulatively result in the expression of osteogenesis, osteoinductivity and osteoconductivity found in autogenous sources.
Department of Orthopedics, Thomas Jefferson University Hospital, Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA. vaccaro3@yahoo.com
Alexander R
AR
Vaccaro
Kazuhiro
K
Chiba
John G
JG
Heller
Tushar Ch
TCh
Patel
John S
JS
Thalgott
Eeric
E
Truumees
Jeffrey S
JS
Fischgrund
Matthew R
MR
Craig
Scott C
SC
Berta
Jeffrey C
JC
Wang
D000818:Animals; D001857:Bone Matrix / Q000637:transplantation; D019485:Bone Morphogenetic Proteins / Q000627:therapeutic use*; D016025:Bone Transplantation; D015316:Genetic Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D013123:Spinal Fusion / Q000379:methods* / Q000639:trends; D013131:Spine / Q000601:surgery*; D014184:Transplantation, Homologous / Q000379:methods
D019485:Bone Morphogenetic Proteins