I’m trying to help my sister avoid the problems I have after a spinal fusion. They took shavings from my hip bone to use as a graft. I had some terrible problems because of it. There must be some new and better ways to do this. What are they?

Spinal fusion is an important and often successful tool for treating chronic low back pain in a patient with an unstable lumbar spine. The surgeon has a wide range of surgical procedures and techniques that can be used depending on the patient’s age, general health, bone density, activity level, and the cause of the problem.

Bone grafting is needed with fusion to help stabilize the surgical site until more bone can grow in and around it to form a solid union. Natural bone material is best. It can be taken from the patient (called an autograft) or from a bone bank (allograft). Autografts for the lumbar spine are usually taken from the iliac crest, the bone you feel when you place your hands on your hips. An alternate site is the tibia (shin bone).

The advantage of autografts is that it isn’t foreign to the patient, so he or she doesn’t react to it and reject it. The disadvantage is that the donor site can become infected, swollen, and extremely painful for a long time after the surgery. Donor site problems are avoided with donated tissue from a bone bank.

There are some new approaches to spinal fusion available and under ongoing investigation. And that’s the use of bone enhancers called bone morphogenetic protein (BMP). A specific bone growth factor (rhBMP-2) has been approved by the Food and Drug Association (FDA) for limited use. This product is put on a special collagen sponge and inserted inside a tiny cage that is then placed between the vertebral bodies. The BMP stimulates bone to grow faster to help create a bridge of bone to fuse the two vertebrae together.

There are some potential problems with this approach, too. This is a biologically active substance, which the body may react to. There can be soft tissue swelling, the formation of seromas (fluid-filled cysts), and even ectopic bone formation. Ectopic means out of place, wrong place, or malpositioned. In the case of lumbar spine fusion, the rhBMP can leak outside of the intervertebral space and form bone inside the spinal canal or around the spinal nerve roots. As a result, serious neurologic problems can develop.

Your sister may want to discuss all her options with the surgeon and find out what might work best for her given her own unique circumstances. Not everyone has a bad reaction to auto- or allografts. Bone enhancers are being used by some, but not all, surgeons. Her surgeon may have a specific protocol or way he or she performs lumbar fusions. The procedure is usually very safe and effective.