Autologous Cancellous Bone Graft: The Gold Standard
Autologous bone is the gold standard with 100 years of peer-reviewed data.
What Graft Properties Offer a Better Chance for Successful Spinal Fusion?
Optimal fusion occurs when a graft material contains properties for osteoinduction, osteoconduction, and osteogenesis.
Since autograft contains the greatest amount of the patient’s own bone growing cells and proteins required for osteoinduction, osteoconduction, and osteogenesis (as compared with other alternatives), autograft offers a better chance of acceptance and effectiveness in the transplant site.
Why You Should Use Autologous Bone in Bone Grafting Applications
Autologous cancellous bone has over 100 years of peer reviewed, published, clinical data for primary arthrodesis, fracture healing, and non-union repair in both peripheral and axial skeletal applications. No other bone graft material has published clinical data sourced from parties without a potential conflict of interest, that compares with autologous cancellous bone graft. So purely on the basis of peer reviewed, published clinical evidence, autologous cancellous bone graft has no equal.
In addition, autologous cancellous bone has all three of the osteogenic properties that are associated with bone graft materials, osteoconductivity (provided by the trabecular bone architecture), osteoproliferation (provided by the hosts native mesenchymal stem cells), and osteoinductivity (provided by the release of native growth factors). While allograft and demineralized bone matrix, are suitable bone extenders, each lack one of the osteogenic properties, making them inferior to autologous cancellous bone graft as a grafting material.
Use of “local bone” harvested at the time of surgical exposure or decompression (e.g. lamina and facet joint fragments) is not equivalent to pure cancellous bone. “Local bone” is composed of residual soft tissue fragments as well as cortical and chondral elements, that are not easily separated from the cancellous bone. These “contaminants”, impede bone healing and can serve as a barrier to bone proliferation and integration. Use of collected bone drill detritus is similarly contaminated by non-cancellous fragments as well as having been dramatically altered architecturally as well as cellularly.
Various autologous bone harvesting techniques that include denuding of cancellous bone’s cellular elements (e.g. usually employing suction), cannot simply be restored or reversed by subsequent addition of sourced cellular elements back into the cancellous bone. Nor can autologous bone architecture provide the same degree of osteoconductivity, if it has been severely altered as a consequence of morselized harvesting.
BMP-2 is an effective bone graft substitute, but it has a number of undesirable properties associated with its use. BMP-2 produces a florid inflammatory response that is associated with adjacent bone resorption. This has been associated with massive soft-tissue swelling (which can be life threatening in the cervical spine) as well as subsidence and loss of implant position (occurring in about 20% to 40% of interbody implants). There is additionally an increased prevalence of post-operative neuralgia associated with the use of BMP-2, when used in proximity to nerve roots. Another complication of using BMP-2 is heterotopic bone formation. BMP-2 is also a relatively costly material.
For all of the above reasons, autologous cancellous bone, when harvested in a minimally invasive manner (to minimize donor site morbidity) has no equal and should be considered as the preferred bone graft material for most bone grafting applications.