The Biology of Spinal Fusion

Allogenic versus autologous cancellous bone in lumbar segmental spondylodesis: a randomized prospective study

“…The chronological course of the fusion rate in CT supports this hypothesis, but cannot be verified with significant results. The different course of consolidation is possibly attributable to a lower biological competence of allogenic cancellous bone; taking into account the osteoinductivity and osteogenic potential [26]. The radiological evaluation of fusion rates must be viewed critically.…”

“…Whether the reduced osteoconductivity or the lack of both, osteoinductivity and osteogenic potential of allogenic grafts ultimately leads to a delayed radiological spondylodesis, remains a matter for future research work [26].…”

“…The current gold standard for lumbar segmental spondylodesis is posterolateral stabilization by means of internal fixation, and ventral intercorporal interposition of an autogenous corticocancellous iliac crest graft [16,23,26]. In the absence of clinical differences, cages augmented with autogenous cancellous bone show similar mechanical characteristics to structural bone grafts [6,18,40].…”

“…Each alternative must be judged against the biological characteristics of the previous standard, based on factors like osteoinductivity, osteoconductivity and osteogenic potential [23,26].…”

“…Biologically, allogenic cancellous bone appears to be inferior in terms of a lack of osteoinductivity and osteogenic potential. There is also a markable risk of interindividual infections [8,26]. The advantages of an allograft lie both in its availability, and in the prevention of a second operation coupled with the associated complication rate.…”