Archive June 2018 XIX, No. 6

Bone Up On Bone Grafts

A breakdown of the materials that help build bones back up.

Daniel Cook

Daniel Cook, Executive Editor

BIO

Scott LaBorwit, MD
REGENERATIVE POWERS Orthopedic surgeon Philip Stahel, MD, FACS, uses bone grafts while performing an open reduction and pin fixation of a complex pediatric elbow fracture.

The human body has tremendous bouncebackability, but when its biologic response isn't enough to regenerate bone lost to injuries or defects, surgeons can reach for a wide array of bone grafts, bone substitutes and biologics to speed the healing process. Bone grafting gives the body a bone-building boost and helps surgeons fuse spines, revise failed joint replacements and fix complex fractures.

Before appreciating how the various graft materials work, you must first understand the 3 mechanisms of action involved in new bone growth: osteoinduction, which involves cells that induce new bone growth; osteoconduction, which involves spacer material on which new bone grows; and osteogenesis, which is when new bone actually fuses with a graft. Bone graft materials and bone graft substitutes have some or all of these properties.

Autograft bone grafts are taken directly from the patient's body, most often at the iliac crest, and demonstrate all 3 properties of bone growth. Donald Corenman, MD, DC, a board certified spine surgeon in Vali, Colo., says spinal fusion procedures can involve obtaining a local autograft by recycling bone spurs or lamina from the vertebra.

Dr. Corenman points to several benefits of using autograft bone: no risk of disease transmission, easy acceptance by the body and optimal healing for a healthy fusion. Potential drawbacks include longer surgical times to harvest the graft and additional post-op pain for the patient. During spine surgery, fusion rates (the percentage of full incorporation of the graft bone with the native vertebrae) involving autograft bone is 95 to 98% at a single disc level, according to Dr. Corenman. He says healing time (how long it takes new bone to become fully incorporated in the body) takes about 6 weeks.

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