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MUSCULOSKELETAL SURGERY

, Volume 99, Issue 3, pp 171–178 | Cite as

Autologous bone graft harvesting: a review of grafts and surgical techniques

  • A. M. JakoiEmail author
  • J. A. Iorio
  • P. J. Cahill
Review

Abstract

Spinal fusion with or without instrumentation often requires the use of bone graft. Bone graft may be autogenous or exogenous. There are various forms of bone graft which may be acquired from numerous sites. Knowledge of fusion biology is imperative for understanding the benefits and limitations of these grafts. Equally as important is the knowledge of outcome measures, management of donor-site morbidity, and potential reconstruction. This review details the methods of obtaining bone graft and details the properties of each, as well as discusses observed outcomes, donor-site morbidities, and reconstruction techniques.

Keywords

Orthopedic surgery Bone autograft Autograft harvesting 

Notes

Conflict of interest

None.

References

  1. 1.
    Finkemeier CG (2002) Bone-grafting and bone-graft substitutes. J Bone Jt Surg Am 84-A:454–464Google Scholar
  2. 2.
    Kalfas IH (2001) Principles of bone healing. Neurosurg Focus 10:E1CrossRefPubMedGoogle Scholar
  3. 3.
    Banwart JC, Asher MA, Hassanein RS (1995) Iliac crest bone graft harvest donor site morbidity. A statistical evaluation. Spine 20:1055–1060CrossRefPubMedGoogle Scholar
  4. 4.
    Kurz LT, Garfin SR, Booth RE Jr (1989) Harvesting autogenous iliac bone grafts. A review of complications and techniques. Spine 14:1324–1331CrossRefPubMedGoogle Scholar
  5. 5.
    Rupp RE, Podeszwa D, Ebraheim NA (1994) Danger zones associated with fibular osteotomy. J Orthop Trauma 8:54–58CrossRefPubMedGoogle Scholar
  6. 6.
    Albee FH (2007) Transplantation of a portion of the tibia into the spine for Pott’s disease: a preliminary report 1911. Clin Orthop Relat Res 460:14–16CrossRefPubMedGoogle Scholar
  7. 7.
    Grabowski G, Cornett CA (2013) Bone graft and bone graft substitutes in spine surgery: current concepts and controversies. J Am Acad Orthop Surg 21:51–60CrossRefPubMedGoogle Scholar
  8. 8.
    Burwell RG (1964) Studies in the transplantation of bone. VII. The fresh composite homograft-autograft of cancellous bone; an analysis of factors leading to osteogenesis in marrow transplants and in marrow-containing bone grafts. J Bone Jt Surg Br 46:110–140Google Scholar
  9. 9.
    Friedlaender GE (1987) Bone grafts. The basic science rationale for clinical applications. J Bone Jt Surg Am 69:786–790Google Scholar
  10. 10.
    Kingma MJ, Hampe JF (1964) The behaviour of blood vessels after experimental transplantation of bone. J Bone Jt Surg Br 46:141–150Google Scholar
  11. 11.
    Benzel EC (2012) Spine surgery 2-vol set: techniques, complication avoidance, and management (Expert Consult—Online). Elsevier Health Sciences (ed)Google Scholar
  12. 12.
    Doi K, Tominaga S, Shibata T (1977) Bone grafts with microvascular anastomoses of vascular pedicles: an experimental study in dogs. J Bone Jt Surg Am 59:809–815Google Scholar
  13. 13.
    Urist MR, DeLange RJ, Finerman GA (1983) Bone cell differentiation and growth factors. Science 220:680–686CrossRefPubMedGoogle Scholar
  14. 14.
    Smith MD, Cody DD (1993) Load-bearing capacity of corticocancellous bone grafts in the spine. J Bone Jt Surg Am 75:1206–1213Google Scholar
  15. 15.
    Ebraheim NA, Elgafy H, Xu R (2001) Bone-graft harvesting from iliac and fibular donor sites: techniques and complications. J Am Acad Orthop Surg 9:210–218PubMedGoogle Scholar
  16. 16.
    Kho VK, Chen WC (2008) Posterolateral fusion using laminectomy bone chips in the treatment of lumbar spondylolisthesis. Int Orthop 32:115–119CrossRefPubMedGoogle Scholar
  17. 17.
    Fischer CR, Ducoffe AR, Errico TJ (2014) Posterior lumbar fusion: choice of approach and adjunct techniques. J Am Acad Orthop Surg 22:503–511CrossRefPubMedGoogle Scholar
  18. 18.
    Niu CC, Tsai TT, Fu TS et al (2009) A comparison of posterolateral lumbar fusion comparing autograft, autogenous laminectomy bone with bone marrow aspirate, and calcium sulphate with bone marrow aspirate: a prospective randomized study. Spine 34:2715–2719CrossRefPubMedGoogle Scholar
  19. 19.
    Radcliff K, Hwang R, Hilibrand A et al (2012) The effect of iliac crest autograft on the outcome of fusion in the setting of degenerative spondylolisthesis: a subgroup analysis of the Spine Patient Outcomes Research Trial (SPORT). J Bone Jt Surg Am 94:1685–1692Google Scholar
  20. 20.
    Sengupta DK, Truumees E, Patel CK et al (2006) Outcome of local bone versus autogenous iliac crest bone graft in the instrumented posterolateral fusion of the lumbar spine. Spine 31:985–991CrossRefPubMedGoogle Scholar
  21. 21.
    Goyal T, Sankineani SR, Tripathy SK (2013) Local distal radius bone graft versus iliac crest bone graft for scaphoid nonunion: a comparative study. Musculoskelet Surg 97:109–114CrossRefPubMedGoogle Scholar
  22. 22.
    Bono CM, Lee CK (2004) Critical analysis of trends in fusion for degenerative disc disease over the past 20 years: influence of technique on fusion rate and clinical outcome. Spine 29:455–463 (discussion Z5)CrossRefPubMedGoogle Scholar
  23. 23.
    Dawson EG, Lotysch M, 3rd, Urist MR (1981) Intertransverse process lumbar arthrodesis with autogenous bone graft. Clin Orthop Relat Res 154:90–96Google Scholar
  24. 24.
    Wolfe SA, Kawamoto HK (1978) Taking the iliac-bone graft. J Bone Jt Surg Am 60:411Google Scholar
  25. 25.
    Jones AA, Dougherty PJ, Sharkey NA et al (1993) Iliac crest bone graft. Osteotome versus saw. Spine 18:2048–2052CrossRefPubMedGoogle Scholar
  26. 26.
    Gore DR (2001) The arthrodesis rate in multilevel anterior cervical fusions using autogenous fibula. Spine 26:1259–1263CrossRefPubMedGoogle Scholar
  27. 27.
    Kim CW, Abrams R, Lee G et al (2001) Use of vascularized fibular grafts as a salvage procedure for previously failed spinal arthrodesis. Spine 26:2171–2175CrossRefPubMedGoogle Scholar
  28. 28.
    Di Bella C, Lucarelli E, Donati D (2008) Historical review of bone prefabrication. La Chirurgia degli organi di movimento 92:73–78CrossRefPubMedGoogle Scholar
  29. 29.
    Hardy JH (1977) Iliac crest reconstruction following full-thickness graft: a preliminary note. Clin Orthop Relat Res 123:32–33Google Scholar
  30. 30.
    Dell PC, Burchardt H, Glowczewskie FP Jr (1985) A roentgenographic, biomechanical, and histological evaluation of vascularized and non-vascularized segmental fibular canine autografts. J Bone Jt Surg Am 67:105–112Google Scholar
  31. 31.
    Sawin PD, Traynelis VC, Menezes AH (1998) A comparative analysis of fusion rates and donor-site morbidity for autogeneic rib and iliac crest bone grafts in posterior cervical fusions. J Neurosurg 88:255–265CrossRefPubMedGoogle Scholar
  32. 32.
    Cohen MW, Drummond DS, Flynn JM et al (2001) A technique of occipitocervical arthrodesis in children using autologous rib grafts. Spine 26:825–829CrossRefPubMedGoogle Scholar
  33. 33.
    Laurie SW, Kaban LB, Mulliken JB et al (1984) Donor-site morbidity after harvesting rib and iliac bone. Plast Reconstr Surg 73:933–938CrossRefPubMedGoogle Scholar
  34. 34.
    Kang J, An H, Hilibrand A et al (2012) Grafton and local bone have comparable outcomes to iliac crest bone in instrumented single-level lumbar fusions. Spine 37:1083–1091CrossRefPubMedGoogle Scholar
  35. 35.
    Ito Z, Imagama S, Kanemura T et al (2013) Bone union rate with autologous iliac bone versus local bone graft in posterior lumbar interbody fusion (PLIF): a multicenter study. Eur Spine J 22:1158–1163PubMedCentralCrossRefPubMedGoogle Scholar
  36. 36.
    Rihn JA, Kirkpatrick K, Albert TJ (2010) Graft options in posterolateral and posterior interbody lumbar fusion. Spine 35:1629–1639CrossRefPubMedGoogle Scholar
  37. 37.
    Saraph VJ, Bach CM, Krismer M et al (2005) Evaluation of spinal fusion using autologous anterior strut grafts and posterior instrumentation for thoracic/thoracolumbar kyphosis. Spine 30:1594–1601CrossRefPubMedGoogle Scholar
  38. 38.
    Dimar JR 2nd, Glassman SD, Burkus JK et al (2009) Two-year fusion and clinical outcomes in 224 patients treated with a single-level instrumented posterolateral fusion with iliac crest bone graft. Spine J 9:880–885CrossRefPubMedGoogle Scholar
  39. 39.
    Schwartz CE, Martha JF, Kowalski P et al (2009) Prospective evaluation of chronic pain associated with posterior autologous iliac crest bone graft harvest and its effect on postoperative outcome. Health Qual Life Outcomes 7:49PubMedCentralCrossRefPubMedGoogle Scholar
  40. 40.
    Kim DH, Rhim R, Li L et al (2009) Prospective study of iliac crest bone graft harvest site pain and morbidity. Spine J 9:886–892CrossRefPubMedGoogle Scholar
  41. 41.
    Robertson PA, Wray AC (2001) Natural history of posterior iliac crest bone graft donation for spinal surgery: a prospective analysis of morbidity. Spine 26:1473–1476CrossRefPubMedGoogle Scholar
  42. 42.
    Gore DR, Gardner GM, Sepic SB, et al (1987) Function following partial fibulectomy. Clin Orthop Relat Res 220:206–210Google Scholar
  43. 43.
    Whitaker LA, Munro IR, Salyer KE et al (1979) Combined report of problems and complications in 793 craniofacial operations. Plast Reconstr Surg 64:198–203CrossRefPubMedGoogle Scholar
  44. 44.
    Summers BN, Eisenstein SM (1989) Donor site pain from the ilium. A complication of lumbar spine fusion. J Bone Jt Surg Br 71:677–680Google Scholar
  45. 45.
    Singh K, Phillips FM, Kuo E et al (2007) A prospective, randomized, double-blind study of the efficacy of postoperative continuous local anesthetic infusion at the iliac crest bone graft site after posterior spinal arthrodesis: a minimum of 4-year follow-up. Spine 32:2790–2796CrossRefPubMedGoogle Scholar
  46. 46.
    Singh D, Gombar KK, Bhatia N et al (2013) Evaluation of analgesic effect of local administration of morphine after iliac crest bone graft harvesting: a double blind study. J Anaesthesiol Clin Pharmacol 29:356–360PubMedCentralCrossRefPubMedGoogle Scholar
  47. 47.
    Asano S, Kaneda K, Satoh S et al (1994) Reconstruction of an iliac crest defect with a bioactive ceramic prosthesis. Eur Spine J 3:39–44CrossRefPubMedGoogle Scholar
  48. 48.
    Harris MB, Davis J, Gertzbein SD (1994) Iliac crest reconstruction after tricortical graft harvesting. J Spinal Disord 7:216–221CrossRefPubMedGoogle Scholar
  49. 49.
    Wang MY, Levi AD, Shah S et al (2002) Polylactic acid mesh reconstruction of the anterior iliac crest after bone harvesting reduces early postoperative pain after anterior cervical fusion surgery. Neurosurgery 51:413–416 (discussion 6)PubMedGoogle Scholar
  50. 50.
    Bojescul JA, Polly DW Jr, Kuklo TR et al (2005) Backfill for iliac-crest donor sites: a prospective, randomized study of coralline hydroxyapatite. Am J Orthop 34:377–382PubMedGoogle Scholar
  51. 51.
    Burton DC, Carlson BB, Johnson PL et al (2013) Backfilling of iliac crest defects with hydroxyapatite-calcium triphosphate biphasic compound: a prospective, randomized computed tomography and patient-based analysis. Spine J 13:54–61CrossRefPubMedGoogle Scholar

Copyright information

© Istituto Ortopedico Rizzoli 2015

Authors and Affiliations

  1. 1.University Orthopedic Institute at HahnemannPhiladelphiaUSA
  2. 2.Department of Orthopedic SurgeryTemple University HospitalPhiladelphiaUSA
  3. 3.Shriners Hospital for ChildrenPhiladelphiaUSA

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