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I have a special problem. I need a spinal fusion for chronic back pain but I can't donate my own bone for the graft because I'm osteoporotic. The surgeon has suggested two possible alternatives: one is using bone from a bone bank. The other is a bone substitute product. Which one is safer and works better?

Most spinal fusions are held together with metal plates, screws, and bone graft material. During the healing process, the body fills in and around the fusion site with additional, fresh bone. The initial graft material placed at the fusion site during the procedure is usually an autograft. Autograft means the bone was taken from the patient. The most common place to harvest bone for the graft is from the patient's pelvic bone. But there are two major drawbacks to this type of autograft. One is the fact that it requires a second surgery. The second is the fact that sometimes the patient's bone quality isn't that good. That seems to be your situation. Bone graft material can be obtained from a bone bank (donated by someone else). Donor graft material comes with its own set of risks and problems. Scientists are actively seeking alternative ways to provide a strong fusion without bone grafting. One of the methods that has been developed over the last few years is the process of using osteogenic proteins. Osteogenic means bone producing. And that's exactly what these bone proteins do. Currently, there are two bone-derived proteins on the market: osteogenic protein-1 (OP-1) and bone morphogeneic protein-2 (BMP-2). Studies are underway comparing these two products to one another and against the current standard (autografts). The jury is not in yet but it's looking favorable for bone proteins. They appear to be safe and effective with very few drawbacks.

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