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Cage Vs. Allograft

Jewel2005JJewel2005 Posts: 59
edited 06/11/2012 - 8:55 AM in Chronic Pain
Anyone know the difference between using a cage rather than an allograft bone for fusion? Which one is a better choice?


  • Those are two completely different things so it's like comparing apples to oranges:)

    With a fusion...a Dr. will choose either Autograft or Allograft.

    Autograft is using your own bone to replace the disc that is taken out. It's taken from your hip bone. My first surgery they did this.

    Allograft is using bone from a deceased person. With allograft...Dr.s are now adding BMP which is Bone Morphogenetic Protein which is like a liquid paste that is put inside the fusion site with a disenegrating sponge. This protein helps it fuse. This was done in my last surgery.

    There are pluses and minuses for both of these.

    In most fusions surgeries, they will use a metal (titanium) cage with plates and screws to connect one verterbrae to another and hold in the new bone and stabilize the spine and help prevent movement.

    So..it's really about what you and your Dr. discuss and how ruptured the disc or discs are, as well as any other spine issues involved.

    The other words you will hear are Anterior or Posterior...

    Anterior approach means from the front..So if it's lumbar or cervical...they will go throught the stomach or neck and attach the cage/plating from that side.

    Posterior is from the back.

    My first two surgeries were Anterior...my last was both Anterior and Posterior...They just flipped me over during the 10 hour surgery..

    It's always recommended to get a 2nd or 3rd opinion from Board Certified Neurosurgeons or BC Orthopedic Surgeons depending on what level of the spine you are getting done.

    As well as they discuss that fusions are done primarily to fix mechanical issues and not take away all of the pain. Yes...there are some people who are lucky to have it all go away...And with mine...it helped with my nerve pain...but I have continued chronic muscle and bone pain.

    So a good Dr. will talk about all of this and the pros and cons of this type of surgery and what to expect for recovery time. The fusion itself can take up to a year.

    Good luck!

  • Lovetrotravel, I see you had up to 4 - C5/6-6/7 fusions. Did the prior ones fail causing you to have it done again? On the rear one did they do a laminectomy? I'm just curious since I had one fusion and it was titanium and I don't wont to go through that again.
  • Hi lbritt...I don't want to hijack too much of Jewel's thread...but I'm happy to answer as maybe it can help her as well as you:)

    I've actually had 3 fusions...(the same two levels each time C5-C6 and C6-C7)

    They only needed to do the fusions and a partial laminectomy added to last one as I didn't have severe spinal stenosis...I just had the discs completely rupture into the spinal cord.

    All 3 of my surgeries were done within a week of seeing the MRI

    The first one...I didn't have any major accident..but am a total adrenaline junkie as well as was a volunteer Firefighter/EMT for 10 years...and did Photography for side jobs..A Nikon was always around my neck! LOL. So with both of those things I had great stress on my neck/back.

    So the first fusion surgery they did the Autograft bone and without any instrumentation (no titanium cage/plate/screws)

    I was in a hard collar for almost 3 months..but I was very lucky in that to this day I haven't had any real trouble with my hip area as many have chronic pain there.

    I actually was pretty much pain free for 2 years after and then started getting pain again and numbness and tingling in my right arm/hand/fingers.

    The MRI showed that the fusion failed on both levels...My bone that was put in..actually reabsorbed into my body...Literally disappeared! So this time the vetebrae was collapsed on nerves and pushing into the spinal cord..But they still didn't do a laminectomy...just needed to do a re-fusion and straighten up the spine.

    Unfortunately I had different insurance and went from my PCP who was wonderful and trying to help the pain..to a terrible PM...who recommended the Neurosurgeon to do the 2nd surgery...They were friends...They were both awful and mean Dr.s!!

    They used Allograft bone and titanium cage/plate/screws also going in from the front of the neck.

    So..upon waking from this surgery...I was in excruciating pain..I just knew that something wasn't right..But the jerk PM said 'you should be fixed now"...and the Surgeon said.."I fixed you..you shouldn't have anymore pain"..and they had given me 5m Percocets...40 of them to deal with surgery pain and that's it.

    It took almost almost a year because of insurance changes, my divorce, death of a family member, finding a new place to live..and not a single medicine besides Advil...before I found my absolutely wonderful PM and Neurosurgeon...Worst year of my life! Unfortunately I now have some permanent nerve damage on my right arm/hand/fingers..They are at 30% less than should be in a regular person.

    As soon as the Neurosurgeon saw me at the first appt..he gave me the biggest hug and said.."We will help you...don't worry..no one should have to have this kind of pain"...They did an MRI and it showed another fusion failure but also terrible placement of all the titanium and was cutting into my nerves and cord.

    So..since I had 2 failures...they needed to do the Anterior and Posterior approach to really shore up my spine this time. And because of scar tissue...all 3 of these surgeries went in different places in my neck in the front so I love those scars! LOL..

    The scar tissue on the back of my neck stings and tugs a lot more...I hardly notice the front now..

    I was lucky that even though I have nerve damage..I don't have a lot of nerve pain anymore...so I don't need any medicine for that right now. My pain is more muscular and bone pain because of all the surgeries..

    Are they convinced that you need the laminectomy? I'm suprised that they are saying this so soon after your cervical fusion....I would think they would give everything a year or so to see if the fusion takes care of your nerve pain..

    Are you on nerve pain medicine now? Does it help?

    I would certainly get 2nd and 3rd opinions on this more so because you have just had two major surgeries within 4 months...which is shocking within itself...You must have had such severely ruptured discs and they needed to avoid paralysis to do those so close together.

    Did they do just Posterior lumbar? or both Anterior/Posterior..

    Even though a laminectomy is usually one of the more successful surgeries in taking away nerve pain...with the one's you have had...I would personally only be doing this if nerve pain medicine was not helping and after seeing if the decompression fusion you had doesn't help after a year.

    I do feel for you!.

  • thanks for your info and no I don't take any pain pills since the first few weeks after surgery. They did say I could be in a wheel chair soon if not for the first 2 surgeries. The lameinectomy may be in the next 6 months or so. He was wanting to prolong the lumbar laminectomy which was posterior. But I insisted he do it asap due to the pain and numbness of the legs. Even with the cervical laminectomy which will be C2-C7 he said it could wait which that was in June and I go back in a few weeks but since I no longer have a job and no insurance until I get on my wifes plan in Dec. I doubt he would do it until then. IO know I will have to wait for a while after on my wife's in due to pre-existing.
  • and sorry Jewel2005 for hijacking your thread.
  • I guess I would just question why the Dr. isn't wanting to try something as simple as nerve pain medication..

    There is Lyrica, Neurontin or Cymbalta as some people do better on one or the other.

    And if something like this helped the nerve pain..as well as wait to see if the cervical fusion helps with the other symptoms...I just can't see jumping to another surgery like that unless they are saying that you will be paralysed without it.

    But then if that was the case...they should have done the laminectomy during the cervical fusion like they did mine...

    Obviously I'm not a Dr...but I would certainly be getting 2 and 3 opinions before I did another major surgery...

    Because there are some Surgeons that only want to cut...and that is not a good thing...That's why it's shocking that they want to do that surgery but aren't prescribing any nerve pain medicine to see if that helps first?
  • I did get 2 other opinions and went with the nero that first saw me since he was the best in the area. The main thing was numbness and not able to get the legs to function due to the cord compression. Even the DR's were surprised I made it out of the hospital after my near death motorcycle wreck last 8/15/10. When I first walked into his office he said it was amazing I can even walk. Now I can walk a few miles on the track when I do my walking exercises. I would doubt nerve meds would help with the compression but it might if pain was the main issue which was not the case the function of the legs and numbness was the worst, pain was 3rd of so on the list. Pain was more in the lower back than the legs. Now I have a slight numbness in the left few toes and few of the left fingers. Which I'm glad I did the surgeries I did and the other one I will have to wait and see in the next few months what I will decide.
  • I was talking more about the decision to do this surgery...not the one's you've already had done...

    So before I did this next one...that is when I would wait to see how the cervical fusion does..as well as try nerve pain medicines..

    So if you only have some slight numbness now...I can't imagine doing a laminectomy at all those levels for just that reason.

    Again..certainly your choice..and the first two sounded very necessary...

    I wish you luck:)

  • thanks. For me I'm going to wait and see in the next 6 months if it stays the same or improves I won't do another surgery. But if it gets worse maybe I will. Right now I feel 90% better than I did pre first surgery. I do know I feel a little better each week so it is getting better. Wish you and all the best outcome from their spinal disorders.
  • That sounds like a very good plan...I'm so happy to hear that you feel 90% better than before the surgeries...that is fantastic!

    I have my good days and bad days with pain levels from 5-7...But I am extremely blessed to have found my wonderful PM and Neurosurgeon that work for the same Spine Institute...so whatever happens ahead for me I'm in good hands...literally! LOL..

    Well..hopefully our sharing will also help Jewel and others and I apologize for taking over her thread..but it's so important for people to see all sided of a story with surgery...Especially there are so many who do have total success who don't come on boards like this..

    Again..glad to hear you are doing so well Lbritt!
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