I'm going to have a neck fusion next month. I have a few weeks to mull over how I want to have the graft done. I can use bone from a bone bank, bone from my hip, or some new product that is a bone substitute. What do most people do?
Spinal fusion surgery has become a standard procedure for degenerative spine conditions that leave the cervical (neck) or lumbar (low back) area painful and unstable. There are many different ways to fuse the spine -- not only in types of materials available, but also approaches (from the front, side, back, or combination of directions) and techniques (with bone grafts, bone substitute, titanium cages, metal plates, screws).
The first place to start in making this decision is with your surgeon. What does he or she recommend? Often there are patient-related factors that guide or direct the decision-making process. Sometimes the surgeon has a preference because of personal experience.
Grafts from a bone bank are preferred by some because the patient doesn't have to deal with the potential complications of donor site pain and poor wound healing. But the bone from cadavers is no longer able to generate new bone growth. It just provides a foundation or support for the body to fill in with its own bone.
Donating bone to yourself (autogenic grafts) may speed up the fusion process. There's no problem with rejection of the graft material and because it's bone that can create or stimulate other bone cells to form, the fusion may take faster. The downside is as mentioned, the possibility of a painful donor site. In fact, some patients find the donor site to be more painful than the surgical site.
The problems with bone grafts of both kinds have prompted scientists to formulate a bone graft substitute. Bone morphogenetic protein or BMP has been developed, tested, and approved by the Food and Drug Administration (FDA) for use in lumbar spine fusions. BMPs have not been formally tested in the cervical spine. But some surgeons have tried them with good results.
BMPs seem to have the ability to induce new bone growth at a very fast rate. The success with this method has convinced many surgeons to switch from bone grafts to BMPs for spinal fusions. In 2002 less than one per cent of all fusions were done with BMPs. By 2006 that number had risen to 25 per cent. On the heels of this success came the use of BMPs for the cervical spine.
There are a couple caveats (cautions) about the use of BMPs in cervical spine fusions. First, since they have not been tested for safety, their use in this part of the spine is considered off-label. The surgeon who originally tested BMPs for the lumbar spine has repeatedly pronounced that these BMPs are not intended (and should not be used) for the neck -- at least not until properly and fully tested.
There have been reports and even one formal study that showed an increased rate of complications when using BMPs for anterior cervical fusion. Anterior means the incision and procedure are performed from the front of the neck/spine, rather than from the back.
A 50 per cent increase in complications led to some serious concerns about the use of BMPs for anterior cervical fusions. Too much bone growth resulted in swelling of the airway, compression of the airway, difficulty swallowing, hoarseness, and poor wound healing. These complications were not minor, but serious enough to potentially be life-threatening.
Talk with your surgeon about these three choices. Ask for his or her personal opinion and recommendations for you specifically given your own unique situation. Hopefully the information here will help you put together some questions that might help you make the right choice for you.