Alternatives to Autologous Bone Harvest in Spine Surgery

Spine fusion remains a common means of achieving stability in spinal surgery. Methods for obtaining fusion involve decortication of the host bed and introduction of a grafting material. Autologous bone has served as the standard material for these procedures in that its three cardinal properties encourage effective bone healing: osteogenic cells, an osteoconductive structure, and an osteoinductive matrix. Further, both cancellous bone with its increased surface area and osteogenic potential and cortical bone with its structural properties may be harvested. However, autologous bone suffers certain drawbacks, particularly a high rate of donor site morbidity, limited amounts of available bone, and the additional operative time required for harvest. For these reasons, intensive efforts have been directed toward developing alternative substances to either augment or substitute for autologous bone in spinal surgery. In this paper, we will examine some of the commonly used and emerging materials and their indications in spinal surgery.