A General Perspective on Use Of Grafts In Spine Surgery

Abstract

Objective: This study aims to provide information about graft materials frequently used in spine surgery and to underline the points of knowledge essential in choosing the right grafts.

Methods: This review study was based on a literature search for studies featuring the use of graft materials in spine surgery. Studies with scientific evidence level I or II were interpreted (randomized-controlled trials or systematical meta-analyses of those, cohort studies with control groups)

Results: The graft materials used in spine surgery can be divided into three groups: autografts, allografts and synthetic materials.Recent years have shown considerable development especially in the field of synthetic grafts. Despite the diversity of newly emerging graft forms, autografts still seem uppermost in fusion success. Some synthetic materials such as bone morphogenic protein are associated with local edema and tissue reactions. Many studies have concluded that allografts or synthetic materials alone cannot provide sufficient fusion. Factors contributing to fusion success were underlined.

Conclusion: Our study has shown that no other graft material is superior to autografts in means of scientific evidence. Allografts and synthetic materials are recommended as an augmentation of fusion. Autografts must be used whenever possible. Osteoinductive growth factors might be added to autografts to improve fusion. The use of bone morphogenic protein and its kindreds should be limited in anterior cervical fusion due to local reactions.