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I'm going to have a spinal fusion at L45 for a spondylolisthesis that is unstable. The surgeon will probably use bone taken from my hip and screws to hold everything together until it heals. Would it be possible to just use the screws without the bone fusion? I have heard a lot about how bad the donor site can be.

Surgeons are studying ways to avoid the problems that can occur with bone graft harvesting. Right now, bone graft is the most common way to fuse one bone segment to another. Bone can be taken from a bone bank (donated by someone else) or directly from the patient (usually from the pelvic bone). There are potential problems with either donor source. Researchers are developing alternative fixation systems to help stabilize the spine. Some have been in use that eliminate the need for bone graft to complete the fusion. It's a fairly new procedure and long-term results aren't available yet. First, surgery is performed to take pressure off the spinal nerves. The procedure is called a decompressive laminotomy. The lamina isn't removed entirely. Just a portion is taken out to remove pressure from the spinal canal. Long screws are placed through the vertebrae to hold it in place. The goal isn't to change the position of the vertebrae. Studies show that external fixation with screws keeps the segment stable over a four-year period of time. However, the system does not prevent degeneration at the next spinal level. And there is a chance that the screws can break or come loose. Further studies are needed with larger groups of patients over a longer period of time. For now, it looks like dynamic stabilization can be used instead of the more invasive bone grafting process.

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