Does Iliac Crest Bone Grafting Still Matter in Spinal Fusion? Here’s What the Research Says
- Taylor Headley
Project Manager, Executive Council, KIC Ventures
In the ever-evolving world of spine surgery, innovation and outcomes go hand in hand. But some debates remain as relevant today as they were decades ago—like whether using autologous iliac crest bone grafts (ICBG) is truly necessary for effective spinal fusion. A study published in The Journal of Bone & Joint Surgery offers compelling data to inform that question.
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This article highlights findings from a subgroup analysis of the Spine Patient Outcomes Research Trial (SPORT), one of the most comprehensive longitudinal studies in spine surgery. The focus? Understanding the impact of iliac crest bone graft on outcomes in patients undergoing spinal fusion for degenerative spondylolisthesis.
Study Overview
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The study looked at 354 patients who underwent lumbar fusion:
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108 patients received posterior fusion with iliac crest autograft.
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246 patients underwent fusion without iliac crest autograft.
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Both groups were closely matched in terms of baseline characteristics and clinical scores, giving researchers a strong foundation for comparison.
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Key Findings
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Operative Time: ICBG patients had longer surgeries (233 vs. 201 minutes, p < 0.001).
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Blood Loss: There was a trend toward increased blood loss in the ICBG group, though it did not reach statistical significance.
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Complications: No significant differences in infection or reoperation rates.
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Outcomes: Patient-reported outcomes—including the SF-36, ODI, Stenosis Bothersomeness Index, and Low Back Pain Bothersomeness Scale—were not significantly different between the two groups over time.
The Takeaway
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This study reinforces a message many spine surgeons may find validating: using iliac crest autograft does not significantly improve long-term patient outcomes, and its omission doesn't appear to increase complications. For many patients and providers, this opens the door to exploring less invasive alternatives like synthetic grafts or allografts without compromising results.
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Why It Matters
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While ICBG has long been considered the gold standard due to its osteoinductive and osteoconductive properties, it’s also associated with:
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Donor site pain and morbidity
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Increased operative time and complexity
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Potential for additional complications
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With FDA-cleared synthetic biologics and advanced DBM materials like NanoFUSE, today’s providers can pursue fusion with materials that reduce risk while still supporting regenerative outcomes.
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Clinical Implications
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Surgeons now have data-backed flexibility. Based on this SPORT subgroup analysis, the decision to use ICBG can—and should—be patient-specific, rather than routine. This aligns with the movement toward minimally invasive, outpatient-friendly spine care solutions.
Want to see what’s next in spinal biologics?
Explore emerging data on synthetic DBM and bioactive glass alternatives that are reshaping fusion outcomes at www.NanoFUSEBiologics.com.