Compare and contrast the healing potential of the anterior spinal column and posterior spinal column with respect to spinal fusion

Biomechanical factors are different in the anterior and posterior spinal columns. In the lumbar region it is estimated that 80% of the body's load passes through the anterior spinal column, and 20% passes through the posterior spinal column. Thus, bone graft placed in the anterior column is subjected to compressive loading, which promotes fusion. In the anterior spinal column, the wide bony surface area combined with the excellent vascularity of the fusion bed creates a superior biologic milieu for fusion. In contrast, bone graft placed in the posterior column is subjected to tensile forces, which provide a less favorable healing environment. In the posterior spinal column, fusion is more dependent on biologic factors such as the presence of osteogenic cells, osteoinductive factors, and the quality of the soft tissue bed into which the graft material is placed. Thus, the posterior spinal column is a more challenging environment in which to achieve a spinal fusion.

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