Not All Autologous
Bone is Equal
While autologous bone is commonly referred to as the “gold standard”, this characterization is most appropriately reserved for cancellous autologous bone that has been minimally manipulated and delivered shortly after harvesting.
Discover why cancellous autologous bone is the ideal choice for bone grafts
The Key Properties Required for Effective Grafts
Osteoinductive
Osteoinductive
Active recruitment and stimulation of stem cells, differentiate into osteoblasts and form new bone.
Osteoconductive
Osteoconductive
Passive scaffold to maintain space and allow for bone formation.
Osteogenic
Osteogenic
Osteogenic living cells, such as osteoblasts, make new bone. Osteoprogenitor cells can proliferate and differentiate to osteoblasts which turn into osteocytes.
Osteoinductive
Active recruitment and stimulation of stem cells, differentiate into osteoblasts and form new bone.
Osteoconductive
Passive scaffold to maintain space and allow for bone formation.
Osteogenic
Osteogenic living cells, such as osteoblasts, make new bone. Osteoprogenitor cells can proliferate and differentiate to osteoblasts which turn into osteocytes.
Cortical Bone (Putties & Local Autograft)
Cortical bone, including “putties” formed from cortical remnants of high speed drilling techniques are very different from architecturally and cytologically preserved cancellous bone.
Local milled bone (cortical autograft) is not as optimal for healing as pure cancellous autograft. Several clinical studies in multilevel fusions have demonstrated this and an athymic rat model (Lee et al, Comparing human “local” bone versus human cancellous bone for spinal fusion in an athymic rat model, The Spine Journal, Volume 2, Issue 2, Supplement 1, March–April 2002) reinforces this understanding.
Adding Cells to Allograft or Milled Local Bone
Adding cells to allograft or milled local bone from marrow aspirate or expanded colonies of mesenchymal stem cells, does not replicate the properties of freshly harvested and minimally manipulated autologous bone.
The evidence for the effectiveness of BMAC is very limited and relatively anecdotal, as it is used with a wide variety of materials and the number of patients enrolled in the clinical studies are relatively low.
Some studies show that concentrating BMAC through centrifugation actually reduces both the total and viable MSC count compared to using unprocessed bone marrow aspirate.
Suction and Auger
Use of suction (which separates marrow elements from cancellous matrix) and auger/curettage techniques (which morselize or disrupt matrix architecture) affects both osteoproliferative and osteoconductive properties of the “gold standard”.
Autologous Bone Cases and Publications
Autologous Bone Grafting in Trauma and Orthopaedic Surgery: An Evidence-Based Narrative Review
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Percutaneous Harvesting of Cancellous Bone Graft: A Surgical Technique Harvesting from the Calcaneus Using COREX
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