INTRODUCTION: Numerous studies demonstrate that bone graft substitutes (BGS) may be comparable to iliac crest bone graft (ICBG), without the additional morbidity. However, current literature suggests that ICBG remains the gold standard. This survey evaluates current opinions and uses of ICBG and BGS in spinal fusion surgery.
METHODS: A survey was distributed at SRS‐2009 and CSRS‐2009. It contained multiple‐choice and short answer questions evaluating demographics, uses, and opinions of ICBG and bone graft substitutes.
RESULTS: Surveys returned: 250 from SRS, 202 from CSRS.
Orthopaedic surgeons: SRS 95%, 77% CSRS,
practiced >10yrs: SRS 66%, 55% CSRS,
perform >100 spine surgeries annually: SRS 73%, 85% CSRS.
Believe they achieve the best fusion rates with:
ICBG alone‐SRS 25%, 34% CSRS,
ICBG +bone graft substitutes‐SRS 11%, 20% CSRS,
Local bone +bone graft substitutes‐SRS 49%, 30% CSRS,
Bone graft substitutes alone‐SRS 3%, 0% CSRS,
Rate unaffected by graft choice‐SRS 12%, 16% CSRS
Expect use of ICBG to remain same/decrease: SRS 92%, 80% CSRS.
Report problems with ICBG donor site morbidity: SRS 81%, 77% CSRS; 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%, 56% CSRS (p=0.67, no significant difference between conferences).
Believe ICBG should no longer be the gold standard in lumbar fusions: SRS 48%, 50% CSRS (p=0.60, no significant difference between conferences).
CONCLUSIONS: This survey emphasizes the significance of donor site morbidity amongst spine surgeons when selecting bone graft material. It indicates that for the majority of spine surgeons, bone graft substitutes represent an acceptable alternative and that ICBG may no longer be the gold standard in spinal fusion surgery.