I’m debating between using donor bone material for a neck fusion and my own bone. I’ve heard that bone bank grafts aren’t alive, so I should use my own bone. But I’ve been told to be prepared for more problems from the donor site than at the actual fusion. Is all this true?

Surgical fusion of the spine for degenerative disease is becoming a popular way to treat this problem. And that’s because surgeons now have at their disposal better ways to perform the surgery and improved hardware such as pedicle screws and locking plates to hold the bones together. Bone graft is also a commonly used material to help get a solid fusion.

Bone grafts can be taken from a bone bank (donated by someone else). This type is called an allograft. Allograft is not osteoinductive or osteogenic. That means it doesn’t cause the body to produce more bone, nor does it produce bone itself. In that sense, it can be considered dead. It just gives a scaffold or place for the patient’s body to fill in with bone produced during the healing phase.

That’s considered one of the disadvantages of allograft versus autograft bone. The up side is that there are no problems at the donor site with pain, infection, or poor wound healing. Autograft (bone taken from the patient) is still alive and capable of producing more bone cells. That’s a benefit as the body fills in the fusion site faster. But then there’s the risk of donor site morbidity (problems) as described.

Sometimes the surgeon uses bone graft material along with metal plating or a device called a cage. Plating anteriorly (from the front of the neck) is usually advised when there are multiple levels being fused. Cages have been made of titanium for the most part. The surgeon fills the cage with bone graft material to help boost the process of spinal fusion. Newer implants made of plastic or porous tantalum are being tried in hopes that fusion rates can be improved with better bone in-growth.