Bone Graft Options, Graft Substitutes, and Harvest Techniques

Successful spine fusion demands careful consideration of bone graft options and meticulous techniques for harvest and arthrodesis. To select the appropriate graft material, spine surgeons must have a working understanding of the factors affecting bone graft healing including osteogenicity, osteoinduction, and osteoconduction, as well as differential healing of cancellous versus cortical grafts. To formulate the appropriate arthrodesis strategy for each patient, the surgeon must weigh individualized patient biologic factors and risks, benefits, and costs of autograft, allograft, and synthetic bone graft substitutes. In patients without biologic obstacles to fusion, such as osteoporosis, diabetes, and steroid use, maximal use of local harvest autograft is suggested, with consideration for remote harvest autograft versus bone graft extenders and enhancers dependent on surgical approach and patient comorbidities. Attention to detail during arthrodesis with meticulous soft tissue removal and decortication of intended fusion surfaces with adequate grafting is necessary.