Table III.

Examples of high-risk cases for spinal fusion surgery¹³

High risk criteria	Patient population
No, or inadequate, volume or poor quality of iliac crest	Previous fusion surgery where autograft was harvested from the iliac crest
	Multilevel fusion requiring large amounts of autograft
High risk for post-harvest iliac crest fracture	Previous fusion surgery where autograft was harvested from the iliac crest
	Previous radiation therapy or other insult to the fusion bed
	Poor bone quality (elderly, metabolic disturbance)
High risk of pseudarthrosis	Revision spinal fusion surgery to treat pseudarthrosis
	Smoker
	Elderly (including osteoporosis)
	Multilevel surgery (particularly where extending to the sacrum or pelvis)
	Previous radiation
	Metabolic disturbance