FAQ - Back

If my doctor uses infused bone graft, will I get as strong a fusion as if he used a bone graft from my hip?

A. INFUSE causes the same bone to form in spinal fusion as would form from using bone graft. The INFUSE fusion comes with a lot less pain.

A. Definitely. In fact, in some cases the bone infusion is significantly stronger or more robust than autograft fusions.

What are infused bone graft-causing side effects?

A. We have used INFUSE since the FDA study in 1998 in more than 300 patients and have not seen any side effects.

A. There have been reports that some patients can develop antibodies to infused or bone morphogenic proteins that are not of the patient's own body; however, no known allergic reactions have been reported to my knowledge.

How is inner fused bone graft made?

A. The human gene for the INFUSE bone forming protein is placed into cells which mass produce it. The protein is thoroughly checked for purity and packaged along with the carrier sponges in a sterile container for surgeon use.

A. This is a synthetic protein initially harvested from animals. A polymerase chain reaction is used to manufacture the protein from this initial donor.

Why is my doctor using a sponge with infused bone graft? What will happen to the sponge? Will my body absorb it like a suture?

A. Surgeons choose to use INFUSE because it forms a solid fusion more reliably than a persons own bone graft, without the pain of the bone graft. With less surgical pain and a more successful surgical outcome, both patient and surgeon are happier. The sponge is incorporated into the new bone that forms.

A. Physicians use infused bone graft because of the potential for a higher fusion rate. There is also no chance of disease transmission as in some allograft donor bones. The sponge that is used for the carrier is also utilized by the protein as a scaffold to help form the new bone that your body develops.

What keeps infused bone graft from growing bone in other places in my body?

A. Any of the INFUSE bone forming protein that drips off the carrier sponge washes out of the body within a few minutes. Bone only forms where the carrier sponge is placed.

A. Infused or bone morphogenic protein works well in areas where there is blood supply. There also has to be a scaffold for infused bone. Usually a scaffold is a collagen sponge. If there is no scaffold and blood the inner fuse will be washed away and will not cause inner bone to form. In fact, this has been the problem to some degree in what we consider posterolateral spinal fusions. The scaffold can still be a cause in sponge; however, the muscles tend to compress the collagen sponge to the point where no true scaffold is present, and no bone forms in a majority of cases.

Is infused bone graft the same as the natural protein found in my body?

A. INFUSE is a manufactured copy of a normal protein present in your body. The protein causes a high concentration of bone forming cells to accumulate wherever it is placed. The protein is placed on a collagen sponge (another normally occurring body protein) to hold it in place. Wherever the sponge is placed, bone will grow.

A. It is a very similar protein to a portion of the group of proteins called bone morphogenic proteins, which were initially isolated in the late 60s.

How does infused bone graft compare to the bone taken from my hip?

A. INFUSE causes the same type of bone to grow as would grow with bone graft taken from a person’s own pelvis. In several studies, INFUSE seems to be even more reliable at achieving fusion than a person’s own bone.

A. In some studies infused, especially used anteriorly, has a better fusion rate than autograft; however, the studies on posterior spinal fusion over the transverse processes have not been complete and have not shown a higher rate of fusion than autograft to date.

What is infused bone graft and how does it compare to natural protein in my body that helps bones to grow?

A. INFUSE is a manufactured copy of a normal protein present in your body. The protein causes a high concentration of bone forming cells to accumulate wherever it is placed. The protein is placed on a collagen sponge (another normally occurring body protein) to hold it in place. Wherever the sponge is placed, bone will grow.

A. Infused bone graft is bone morphogenic protein that is very similar to a group of proteins that are naturally occurring in your body. The main difference with infused is that we use a supranormal dose in order to jump-start the healing process and get cells to come to the area that will cause bone formation.

I have heard people talk about hip pain after harvesting lasting up to two years or longer. Is that true?

A. Pain is the major complication from harvesting bone graft. It can last long term in as many as 20% of patients, though we probably do not know the actual percentage.

A. In many patients bone graft harvesting site pain lasts over two years and sometimes is permanent; however, the majority of patients do not have a permanent problem with this, and it usually lasts less than two years.

My spinal specialist said that he will perform the fusion from my back and will harvest bone from my hip without a separate incision. Will I be able to tell the difference between that pain and the main procedure pain?

A. Bone graft site pain is usually centered over the harvest site on the back of the pelvis. It is often perceived to be in a different area (left or right of midline) from surgical pain (usually midline). Some patients cannot distinguish between the two areas of pain and it feels like one large area of pain.

A. Most patients will have pain that is more manifest in the buttock and pelvic areas than in the spinal fusion area, and this is easily identifiable for most patients. The pain also usually subsides quicker from the spinal fusion area rather than the bone graft site.

Are there any potential complications of harvesting bone from my hip?

A. Pain is the major complication from harvesting bone graft. It can last long term in as many as 20% of patients, though we probably do not know the actual percentage.

A. The potential complications for bone graft harvesting include bleeding from vessels in the buttock. Other complications and more common complications include infection in the area. Lastly, fracture can occur secondary to bone graft harvesting.

I have heard people talk about the pain associated with harvesting over the hip. Does this happen to everyone and how long does it last?

A. When the pack of the pelvis is thinned to harvest bone graft, pain is the natural result. That pain usually goes away in several weeks. About 20% of patients have some lasting discomfort at the site, whether sporadic or constant. Narcotic pain medication occasionally required.

A. Pain from the bone graft site occurs in every person; however, it is not longstanding in every person. In approximately 30% to 40% of people, they will have longstanding bone graft pain depending on how it is taken. These numbers vary depending on the author who has written the papers.

What are the differences between taking bone from the hip and donor bone?

A. A person’s own bone fragments contain live bone forming cells. This has the best chance (next to INFUSE) of leading to a solid fusion. Though less reliable in achieving fusion, bone can also be used from a bone bank. This type of bone does not have any live cells capable of creating new bone. Instead, it forms a framework into which new bone can grow.

A. Bone taken from your body has no chance of disease transmission. In addition, bone taken from your pelvis has all of the skin cells that are capable of becoming bone as well as a nice scaffold, which is the actual bone that the body needs to form a new area of bone. Donor bone usually only has the scaffold and does not have any actual capability of forming bone, i.e. cells. Donor bone can also cause disease transmission, rarely.

Are there any alternatives to having a bone graft taken from the hip?

A. A person’s own bone fragments obtained from decompressing the spinal nerves can be saved and used for graft. Bone can also be used from a bone bank, though this type of bone does not have any live cells capable of creating new bone. A very reliable option is INFUSE, a small sponge with genetically engineered protein that will cause bone to form wherever the sponge is placed.

A. At the present time, bone morphogenic protein can be used in some areas of the country for spinal fusion; however, insurance companies are limiting its use secondary to the expense. Other options include allograft bone, which does not have as high a fusion rate usually. Lastly, synthetic grafts such as beta- tricalcium phosphate with bone marrow aspirate can be used with very similar fusion rates to allograft.

My spine specialist said he will take the bone from my hip. How big is that incision compared to the spine surgery?

A. For almost all spine surgeries, bone graft material can be obtained from the back of the pelvis through the same incision used to perform the spine surgery. It is rare that any additional incisions are needed.

A. Most surgeons in the current day use the same incision as the lumbar spine surgery so no further incision is needed outside of the previous incision; however, some surgeons will make a small incision over the iliac crest if the surgery is in a different area such as in the back of the neck or in the thoracic spine. Usually these incisions are no longer than a couple of inches long.

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