Should I have allograft or autograft bone

Dr. Randy Davis
Glen Burnie, MD
This question is a question for the individual surgeon. It has been my experience that the results of decreased pain and early return to mobility without having to take a piece of bone from the pelvis is so great that I personally prefer the use of allograft or tissue bank bone.
Dr. Mark Testaiuti
Haddonfield, NJ
Autograft bone is best and preferred. It may not be as advantageous for one-level patients in excellent health, as it is with multi-level fusions or in patients that smoke. For one or two levels it may not be noticeable.
Dr. Joseph Alexander
Winston-Salem, NC
There are a number of different operations that are called cervical fusions. For some of these operations, it is perfectly reasonable to use bone from a bone bank, or "allograft" bone. "Autograft" bone, or bone harvested from that specific patient, usually from another area of the body, remains the gold standard in terms of fusion rates. However, there are the increased complications in pain from harvesting that bone. For many operations, the trade-off of risks between a slightly lower fusion rate, versus the increased discomfort and complications from bone harvest, need to be discussed between the patient and their physician.
Dr. Sean Salehi
Chicago, IL
Autograft is rarely used anymore. Allograft which is bone from the bone bank is the primary source of bone used in spinal surgery.
Dr. David S. Baskin
Houston, TX
This is also a decision that should be made with your doctor. The overwhelming majority of patients do just as well with allograft bone (bone from the bone bank), and avoid the pain associated with harvesting a piece of bone from the hip, which can be considerable.
Dr. Brian Subach
Atlanta, GA
Most single-level fusions heal well with allograft bone. In high risk cases, such as re-operation, smokers, multi-level disease, and poor bone quality, autograft may represent a specific advantage.
Dr. Mark R. McLaughlin
Princeton, NJ
I recommend allograft bone for anterior cervical fusion unless the patient is smoking. If they are smoking, I give them the option of autograft (and I recommend it).
Dr. Theodore A. Belanger
Charlotte, NC
Autograft bone is your own bone, usually taken from your pelvis (or "hip"). This live bone contains bone cells and proteins that stimulate bone formation in the site in which it is implanted. Allograft bone is bone from a donor that has been sterilized. It contains no cells or proteins to stimulate bone formation. While autograft clearly works better to produce fusion, allograft also may be adequate in some circumstances, and allow a patient to avoid the second incision and other risks associated with the bone graft harvest site. Discuss this with your spine specialist to determine which type of bone is right for your specific situation.
Dr. Kambiz Hannani
Los Angeles, CA
Autograft is your own bone and has the advantage of better healing potential and less risk of infection. However, autograft bone is removed from the hip, which may cause additional pain. Some patients have continued to experience the hip pain for more than a year after surgery. Allograft is cadaver bone that carries a low risk of infection but is not as effective in creating fusions. For fusions at one site on the spine, allograft is almost as effective as autograft without the complications of taking your own bone. For multi-level fusions, or fusions in several areas of the spine, you need to discuss the risks and benefits of autograft versus allograft with your surgeon to make the best decision.
Dr. Daniel Resnick
Madison, WI
The decision whether or not to use allograft or autograft bone is based upon many factors including both the patient's smoking history, the patient's age, the degree of osteoporosis and the use or non-use of an anterior cervical plate. This is an individualized decision and the patient's own preference is very important in making this decision. Some patients would prefer not to have any foreign material implanted into their bodies and other patients are very eager to avoid the potential pain and morbidity of a graft harvest. This is something that really needs to be discussed on an individual basis.
Dr. Douglas Slaughter
Mesa, AZ
For a single-level fusion from the front or anterior aspect of the neck, it makes no difference whether you have allograft or autograft. For multi-level fusions, i.e. more than a single level through an anterior approach, it has been shown that autograft is a better choice.
Dr. Moe R. Lim
Chapel Hill, NC
The choice of allograft versus autograft is made on an individual basis depending on the patient preferences, if the patient smokes, and the type of procedure being performed. Generally, using your own bone will give you the best chance at successful fusion. However, harvesting your iliac crest hip bone can cause pain and other complications.
Dr. Jeffrey C. Wang
Los Angeles, CA
The patient's own bone is the best quality bone to use for a cervical fusion. Bone taken from the patient's own skeleton will be a living piece of bone that has the patient's own bone cells and will have a higher fusion rate than using cadaver or allograft bone. Allograft bone is an excellent option for a single-level fusion; however, for multiple level fusions the patient's own bone is the best option.
Dr. Jeffrey Goldstein
New York, NY
People do ask whether or not they have to take their own. If people have talked to somebody else who's had the operation then they also know that that's the site that causes them the most pain or the most problem. So most people don't want to have hip graft if they don't have to. There are some people who don't like the idea or have some major concerns about using donor bone in which case they prefer to have their own bone. For a one level instrumented fusion and a two level instrumented fusion for a non smoker, non diabetic, non rheumatoid, I think allograft bone is quite effective. But in people who have the potential for a pseudoarthrosis, or a non-healing of the bone, whether it is heavy smoking diabetic or multi-level fusion then I recommend that they use their own bone.
Dr. Dennis G. Crandall
Mesa, AZ
The fusion rates for autograft and allograft for single level fusions is the same. There is pain associated with the autograft harvest site, so we use allograft whenever possible.
Dr. Allan Levi
Miami, FL
The selection of allograft or autograft bone by yourself and your surgeon should be a carefully balanced decision. There are clearly advantages associated with either approach. In general, use of autograft bone generally obtained from the region of the pelvis has a higher rate of fusion. However, there can be significant pain associated with harvesting the bone graft, ranging anywhere from 5-20%. While allograft bone may have a slightly smaller fusion success rate than bone that is taken from a bone bank and not from the patient himself, the pain associated with graft harvest is not a consideration.
Dr. Kevin Yoo
Escondido, CA
Nowadays, fusion rates are reaching almost 100 percent because of the availability of bone stimulating proteins as well as good allograft bone. Therefore, your surgeon does not need to use your own bone (autograft) unless you are a heavy smoker. In this case, I would recommend that you have your surgeon use your own bone as well as bone stimulating proteins.
Dr. Paul Saiz
Mesa, AZ
The cervical spine has an excellent rate of fusion with allograft bone. Allograft bone refers to cadaver bone which is essentially a calcium scaffold with no live cells. In looking at the fusion rates between taking bone from the hip of the patient vs. cadaver bone at best there is a one to two percent difference in fusion rates.
Dr. W. Christopher Urban
Glen Burnie, MD
Bone taken from a patient’s hip (autograft) is considered the gold standard in terms of bone grafts. It possesses three properties that help to promote bony fusion. It provides a bony architecture where bone can grow, it possesses precursor cells that can form into bone cells, and it contains proteins that stimulate cells to make bone. Donor bone, in contrast, only provides a bony scaffold where bone can grow. The advantage of using donor bone is that it avoids the problems, such as pain and bleeding, associated with harvesting bone from the patient’s hip. As a result of improved instrumentation and safer preparation of allograft tissue, fusions are done with greater success and less pain compared to techniques that involve bone graft harvesting. For these reasons, allograft fusions supplemented with a cervical plate allow for a quick recovery, high fusion rate, and excellent patient satisfaction.
Dr. Brett Taylor
St. Louis, MO
This is a personal decision the patient should make after receiving educational information from his or her surgeon. Allograft bone is a very safe product; however there are risks associated with allograft including disease transmission and decreased fusion rates. Autograft bone is best for obtaining fusion. However, it is associated with pain at the site where the bone was harvested, which may last a significant length of time.
Dr. Robert S. Pashman
Los Angeles, CA
This is decided on an individual basis. In general, I use an allograft (donor bone) in single-level fusions and autograft (bone graft taken from the patient's hip) for multilevel fusions.
Dr. Timothy C. Ryken
Iowa City, IA
I prefer allograft bone due to the additional discomfort associated with bone graft harvest. The fusion rates may be slightly higher using autograft bone.
Dr. Sebastian Lattuga
Rockville Centre, NY
The bone from the fusion can either come from you (autograft) or from transplant (allograft). There are pros and cons to both. The primary advantage to autograft is that the fusion rates are slightly higher, however, there is a significant amount of pain associated with obtaining the bone from the patient's hip. The advantage of allograf is that there is no donor site (hip) pain, however, there is a slight risk of disease transmission.
Dr. B. Theo Mellion
Carbondale, IL
Most people do not want to have a hip graft (autograft) if they do not have, as they may have heard that the graft site will probably cause them the most pain or the most problem. There are also some people who do not like the idea, or have some major concerns about using donor bone in which case they prefer to have their own bone used. For a one or two level instrumented fusion in a non-smoker, non-diabetic, non-rheumatoid I think allograft (donor) bone is quite effective. But in people who have the potential for a pseudoarthrosis, or a non-healing of the bone, whether it be heavy smoking, diabetes, or multi-level fusion, then I recommend that they use their own bone.
Dr. Rick Sasso
Indianapolis, IN
Very good question. There are advantages and disadvantages to each of those. The disadvantage of autograft bone, using your own bone, is the fact that the bone has to be harvested from your iliac crest. Without a doubt, the most common complication of this operation in the neck is all related to where we harvest the bone from the pelvis. And recent data shows that up to 30 percent of patients have continued symptoms two years after their operation. Now, usually those symptoms aren't bad - they're not horrible, but that obviously is not optimal. If you come to see me as a patient with neck and arm pain, but no hip pain, and I make your neck and arm pain go away, but I give you hip pain in exchange, that doesn't make me so happy, and that obviously doesn't make you very happy. The advantage of using allograft bone is that we can completely alleviate the most common cause of complications from anterior cervical fusion.

The commentary above recounts the experiences of these physicians. Medtronic invited them to share their stories candidly. Keep in mind that results vary; not every patient's response is the same. Talk with your doctor to learn more about any products that are mentioned above.

It is important that you discuss the potential risks, complications and benefits of spinal surgery with your doctor prior to receiving treatment, and that you rely on your doctor's judgment. Only your doctor can determine whether you are a suitable candidate for this treatment.

Published: May 04, 2007
Updated: April 19, 2010