Bone Graft and Alternatives
Image
Bone graft is the name given to a piece of bone taken from a part of the skeletal system and used to heal or strengthen the diseased area. The materials used as bone grafts can be taken from the person's own bones, or they can be cadaver-sourced or synthetically produced materials. All of these materials are used to fill the gaps formed in spine pathologies (such as infection, trauma, tumor, degeneration, deformity) and to provide fusion.
The bone piece taken from the patient's own bone system to be placed in the spine for fusion purposes is called autograft. The most commonly used area as a graft source is the hip bone. Depending on the size of the graft or pathology that needs to be taken, ribs or leg bones can also be used as sources. The most reliable type of graft is autograft, as there is no tissue compatibility problem and no risk of disease transmission from person to person. Since it carries the patient's own bone cells and proteins, the likelihood of tissue rejection is low. It also has excellent potential for fusion because it contains its own cells. The most important disadvantage of autografts is the need for a second surgical opening in the same patient. Making a second incision for bone harvesting prolongs the duration of the surgery and may lead to increased complications such as surgery-related infection and risk of blood loss. Another disadvantage is the long-term pain that may occur after surgery in the area where the bone graft is taken.
A graft taken from another person is called an allograft. Allografts are generally obtained from cadavers. It is thoroughly cleaned and cleared of microorganisms using various methods to prevent the transmission of disease from person to person. Despite this, there is a possibility, although at a very low rate, that it may carry diseases that can be transmitted from person to person. With developing technological opportunities, for example, the probability of carrying HIV infection has decreased to one in a million. Although allografts, like autografts, provide a good bone framework for new bone formation, the fact that they do not carry the patient's own cells and proteins is a disadvantage for union. However, the rate of fusion in allografts is as high as in autografts. The most important advantage of using allograft is that there is no need for a second incision and therefore there is no risk of complications. It is the feature of protection from future complications. However, it should not be forgotten that the production of allografts increases the cost of surgery because it requires a certain cost.
What are Bone-Like Products?
Since both autograft and allograft have advantages and disadvantages, a search has been made for new materials that will replace these grafts and have their positive properties. . Although it has not yet fully achieved the desired properties, bone graft alternatives used in spine surgery for fusion purposes are as follows:
Demineralized bone matrix
It is essentially a material produced from allograft. This matrix is produced by decomposing the allograft and removing minerals such as calcium, which provide the hard structure of the bone. This fusion material contains only collagen, proteins and growth factors found in bone. It is produced in various forms of use, including powder, granule and gel. One of these products is used in necessary areas. Since demineralized bone undergoes many processes during matrix production, it is less likely to carry disease than allograft bone. Its most important disadvantage is that it cannot be used as a bone roof. If load-bearing properties are required in addition to fusion, it must be used with materials that will serve as a roof.
Ceramics and similar products are synthetic products produced in a wide variety of forms, used instead of bone grafts. There is no possibility of carrying disease. Although it serves as a framework for bone formation, it does not contain proteins or cells that will enable ossification. Therefore, it should be used with bone grafts that contain these features.
What is Fusion?
Our spine, which provides our ability to stand upright and move, is composed of various movement segments. Fusion is the process of fusing bones together to eliminate movement in two or more movement segments in the spine, in order to eliminate the disease that occurs for any reason in the movement segment and the consequences of the disease.
Factors That Prevent or Delay Fusion Formation.
There are various factors that inhibit bone healing. The most common of these are smoking, diabetes or some autoimmune diseases. If you have one or more of these risk factors, see your doctor. Your doctor will warn you and give you suggestions to ensure post-operative fusion.
Read: 0
