Bone graft vs donor bone??

[emma12]

At our last meeting with our surgeon the issue of bone grafting was brought up again. This time, he is suggesting the use of donor bone rather than taking the bone from our daughter. When we talked about this in March, he suggested using her bone from the hip, now his tendency is to use allograft bone from the bone bank. I realize there is an added risk of using bone from a bank, however, it would eliminate the pain... at the sight of the graft on our daughter. We need to decide soon which way to go, which way has everyone else gone with this?

[geo]

Hi Emma,

My surgery is in a week, and my doctor told me he prefers to use donor bone for me. His reasons are that I am young (30), healthy, have never been a smoker, am active, haven't had diabetes, and that it would be one less painful incision site.

I was worried about that for awhile, because there is a lot of literature that states that bone graft is the preferable way to go due to safety, fusion rates, etc. The more I read, though, I found that what he said makes sense and is what I prefer also. The below website has some useful feedback from several doctors:
http://www.back.com/faq-differencesbetweenbone.html

Many of them mention the risk of disease from donor bone is so small that it's almost theoretical; they also mention that when donor bone is used in conjunction with instrumentation, the risk of non-fusion is greatly reduced.

[scoliboymom]

My son's surgeon used neither donor graft or his hip bone. Instead he told us he used bone fragments from the decortification of the spine. I don't know exactly what this means but I think they take off the knobs of bone on the vertebrae anyways in order to place the screws/rods so the surgeon just used this bone for the fusion. I am sure there is a reason but I don't know why all doctors don't use this bone, maybe because different techniques don't remove these knobs? The other thing is if they are cutting the ribs they could use that bone. You may want to ask about this.

[laurieg6]

Our surgeon said he was going to use shavings from my son's vertebrae first & if more was needed, he'd use bone bank bone. I'm not sure how much from the bone bank was used. I was told it was very safe...

[nzgirl]

I had a rib taken from the hump side of my rib-cage. This helped to reduce the appearance of the hump also I believe. This time around I'm hoping to convince him to use donor bone, but I don't think it's standard practice at all here in NZ. I'm interested in hearing from others who have had donor bone or hip grafts to see how actively I want to pursuede my surgeon.

[always smilin']

I had surgery in the 1980s - and a graft taken from my hip bone. I know that it has always been a little stiff in the cold - but in the last 2-3 years I am in a lot of pain - especially when weather changes. My hip actually hurts worse than the back ever did/does. I would tend to lean towards a donor - but am not up to date on all the background. All I know is that for me the pain has gotten more severe over the years - to the point that there are days where getting out of bed is a bit of a slow process. (Although I am a VERY active person and refuse to let pain or back keep me down at all). From my reading about 30% experience on-going pain after a graft???

Good luck with your decision - just know that whatever you decide is what you deem to be in your child's best interest - never feel guilty about that!

[emma12]

Thanks for all the opinions, the link was especially helpful. I still have not decided (must decide by tomorrow), but think that we are going with the donor bone. I am trying not to struggle with these decisions, it is tough. I keep second guessing everything, which I know I should not be doing. Hopefully, all will go well we can only try to do the best that we can.

[Karen Ocker]

bone from bone bank vs one's own bone

When doing the fusion the spinous processes(the knobs you feel over the spine) are shaved as well as other parts of the spine to prepare the surfaces for fusion. The bone is then denuded and bleeds. When the correction is obtained and the instrumentation is placed the bone obtained from the "shavings" are layred across the denuded bone to start the fusion process. Usually there is not enough bone from a person to accomplish this so bone from the bone bank is used. When a thoracoplasty(hump reduction) is performed those rib pieces are used also(they don't go to waste) but even then donor bone is needed.

Personally, I do not understand why you need to make the decision at all unless you want to avoid the extra incisions to "harvest" the bone from the hip; that I could understand.

[ecnw]

I sometimes have slight pain in the hip area of my bone graph during cold weather, nice to know I'm not alone.
I'd talk again to your doctor to find out his reasoning on using donor vs. one's own. My kids' doc likes to give all the options, but it is ultimately my decision on what happens to my child.
Good Luck, Emily

[rainbow2010]

I had a bone graph from my hip and I have a lot of pain with it. My daughter had donor bone. She refers to it as Sir Francis. If she does something wrong, she says Sir Francis made her do it! Donor bone is very safe. There was a lot about it in the news a couple of years ago due to sick people stealing bones from funeral homes and selling them. As our daughter's doctor explained, you have a greater chance of infection from surgery than getting anything from donor bone. It is screened, processed and safe.

[tulsamom.]

My daughter, Shelby was a year post op in June. Her surgeon told me in the beginning they would take a bone graft from her hip. Then after surgery he said he decided to use the bone chips from drilling the holes in her spine and also used donor bone. He said she was too young (12) to have pain in the graft site for the rest of her life. I was thrilled as I had read so many stories about people 10 years post op still having pain in their hip.

Kathy
Daughter Shelby 13 years old
Before 44T 64L
Posterior Spinal Fusion June 19, 2006
After 10T 10L
Fused T4 to L4

[Mom37]

Did you decide?

Our surgeon said he was going to use shavings from my son's vertebrae first & if more was needed, he'd use bone bank bone. I'm not sure how much from the bone bank was used. I was told it was very safe...

My 13 year old daughter just had surgery August 1st at Texas Scottish Rite Hospital for Children and our understanding is the doctors did the same as the above patient. We were told that their preference was not to use hip due to the reports of pain of the incision on the hip was worse than the back pain and incision. We were told it was vdery safe also. Best wishes to you.

[emma12]

Thanks to everyone who replied, my daughter's surgery was Aug 22 and I chose to use the donor bone along with the bone he was able to use from the vertabrae. Also, he said he uses some bone marrow taken from her hip by injection to mix with the donor bone to add some "live cells" which help the fusion to grow. Everything went reasonably well, we got home from the hospital Monday night (could have stayed another day, but she chose to come home). I am glad she doesn't have the additional pain from the graft site to worry about. I am so relieved the worst appears to be behind us, the stress and worrying I did (and I'm sure she did) before the surgery was hard to handle. After a couple bad days, she is now progressing well, went for a 10 minute walk yesterday, and is surprisingly not having that much pain for what she has been through.

Her back looks great now, the upper curve was corrected down to about 15T, the bottom curve was thought to be a compensating curve so he didn't correct it. She is leaning far and the doctor told her to look in the mirror to see what should be straight so she can retrain her muscles to go that direction. Also mentioned that it is possible she may need a brace to help retrain her back (I am praying that she doesn't need that, would be very tough to handle for her), he'll decide when we go back in 3 weeks.

Thanks again everyone, your comments helped me feel comfortable going with the donor bone, and I am very glad we chose that route.

[Mom37]

Great to hear!

I am glad everything is going well. My daughter is doing great too.

[laurajo0228]

Hi Emma,

My daughter has had 2 fusion surgeries, the first one last year for spondylolisthesis. She was fused from L4 to S1 & the doctor used bone from her hip for the graph. Of course, that meant she has 2 scars from that surgery & there was additional pain from the graph site. She had the 2nd surgery this summer & was fused from T2 to L1 to correct her curves & donor bone was used. At her last check up on 09/11/07, the donor bone was starting to fuse and there are no problems. The decision is yours, but we have found no problems with either way, except the additional scarring from the first surgery.