Table 1.
Summary of bone graft alternatives in ALIF procedures
| Graft option | Fusion rates (%) | Type of graft | Properties | Advantages | Disadvantages | Complications with graft | Cost† | |||
|---|---|---|---|---|---|---|---|---|---|---|
| Osteogenesis | Osteoconduction | Osteoinduction | Strength | |||||||
| Autograft | 51.9–100 | Cancellous bone | +++ | +++ | ++ | − | Host tissue; natural biological properties | Finite supply, increased surgical time, blood loss, pain | DSM | Nil |
| Cortical bone | + | + | + | − | ||||||
| Allograft | 42.8–100 | No DSM, abundant supply, versatility as extender and/or graft | Risk of bacterial contamination, viral transmission, host rejection. | Graft collapse | ++ | |||||
| Cancellous | Fresh‐frozen | − | ++ | + | − | |||||
| Freeze‐dried | − | ++ | + | − | ||||||
| Synthetic | ||||||||||
| DBM | 90* | − | + | ++ | − | No DSM, useful as bone extender | Lacks strength, only one ALIF clinical trial | Graft collapse | ++ | |
| Ceramics | 79.3–100 | − | +++ | − | + | No DSM | Not effective as stand‐alone, lack of ALIF clinical trials | Cage subsidence | + | |
| rhBMP‐1 | 44–100 | − | ++ | +++ | ++ | No DSM, very potent osteoinductive properties, high fusion rates | Rare, costly, uncertainty surrounding appropriate clinical dosage | Heterotopic bone formation, early osteolysis, graft subsidence, inflammation | +++ | |
*only one clinical study on application of DBM to ALIF has been conducted; †cost of grafts are approximate and relative only. DBM, demineralised bone matrix; DSM, donor site morbidity; rhBMP‐2, recombinant human bone morphogenetic protein 2; “+” and “−” represent relative strengths of properties, with “+” meaning the presence of the property, and “−” meaning its absence.