How does the location and site of spinal fusion influence the choice of graft material

Biologic factors and biomechanical factors are different in the anterior and posterior spinal columns. Bone graft placed in the anterior column is subject 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. Extremely high fusion rates are typical whether a surgeon uses autograft or allograft bone. In contrast, bone graft placed in the posterior column is subjected to tensile forces, which provides 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 and osseous bed into which the graft material is placed. In view of this more challenging healing environment, autogenous iliac bone graft has traditionally been the gold standard for achieving posterior spinal fusion. Regional differences along the spinal column influence healing of posterior fusions with the highest fusion rates associated with cervical and thoracic fusions and the lowest rates with posterolateral lumbar fusions.

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