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Is Iliac Crest Bone Graft Still the Gold Standard in Spinal Fusion Surgery? A Survey of Spine Surgeons: Paper #99

Aubin, Michelle E MD; Eck, Jason C. DO, MS; Lapinsky, Anthony MD; Connolly, Patrick J. MD

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Spine Journal Meeting Abstracts: 2010 - Volume - Issue - p 114
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Summary: We surveyed spine surgeons at SRS‐2009 and CSRS‐2009 regarding opinions of iliac crest bone graft (ICBG) versus bone graft substitute (BGS) in spinal fusion surgeries. 452 surveys were returned with similar results at each conference. Donor site morbidity is a significant concern in graft selection; the majority did not feel that ICBG should remain the gold standard in anterior cervical fusions and half felt that it should not remain the gold standard in lumbar fusion surgeries.

Introduction: Numerous studies show BGS may be comparable to ICBG, without the additional morbidity, but current literature suggests that ICBG remains the gold standard. This survey queries spine surgeons regarding current opinions and uses of ICBG and BGS in spinal fusion surgery.

Methods: A survey was distributed at SRS‐2009 and CSRS‐2009 containing multiple‐choice and short answer questions evaluating demographics, uses and opinions of ICBG and BGS.

Results: Surveys returned: SRS 250 (41%), CSRS 202 (48%), total 452.

The demographics for the conferences were as follows:

Orthopaedic trained surgeons: SRS 95%, CSRS 77%,

Academic: SRS 45%, CSRS 78%,

In Practice >10yrs: SRS 66%, CSRS 55%,

Perform >100 spine surgeries annually: SRS 73%, CSRS 85%,

Practice within the US: SRS 74%, CSRS 78%,

Believe they achieve the best fusion rates with:

ICBG alone: SRS 25%, CSRS 34%,

ICBG + bone graft substitutes: SRS 11%, CSRS 20%,

Local bone + bone graft substitutes‐SRS 49%, CSRS 30%,

Bone graft substitutes alone‐SRS 3%, CSRS 0%,

Rate unaffected by graft choice‐SRS 12%, CSRS 16%,

Expect use of ICBG to remain same or decrease: SRS 92%, CSRS 80%,

Report problems with ICBG donor site morbidity: SRS 81%, CSRS 77%; this was also the most commonly listed reason for avoiding ICBG use at SRS and CSRS.

Believe ICBG should no longer be the gold standard in anterior cervical fusions: SRS 58%, CSRS 56% (p=0.67, no significant difference between conferences).

Believe ICBG should no longer be the gold standard in lumbar fusions: SRS 48%, CSRS 50% (p=0.60, no significant difference between conferences).

Conclusion: These findings indicate that donor site morbidity strongly influences graft selection. Finally, it appears that the majority of spine surgeons may no longer consider ICBG to be the gold standard in spinal fusion surgery.

Significance: This survey indicates that for the majority of spine surgeons, donor site morbidity strongly influences graft selection and that BGS is considered an acceptable alternative to ICBG. It also indicates that ICBG may no longer be considered the gold standard in spinal fusion surgery.

© 2010 Lippincott Williams & Wilkins, Inc.