Name of the Procedure:

Bone marrow aspiration for bone grafting, spine surgery only, through separate skin or fascial incision
Technical Terms: Bone marrow aspiration, autograft, spinal surgery

Summary

Bone marrow aspiration for bone grafting is a procedure where bone marrow is extracted from one part of the body and used to enhance bone healing and fusion in spine surgery. The process involves making a small incision in the skin or fascia separate from the main surgical site.

Purpose

This procedure is used to treat conditions requiring spinal fusion, such as spinal instability, degenerative disc disease, or spine fractures. The goal is to use the patient's bone marrow to improve the healing process and ensure better integration of the bone graft.

Indications

• Chronic back pain requiring spinal fusion
• Spinal instability due to degenerative disc disease
• Spine fractures needing surgical correction
• Previous failed spinal surgeries needing enhancement

Preparation

• Patients may need to fast for 8 hours prior to surgery.
• Blood tests and imaging studies (e.g., X-rays, MRIs) to assess the spine and overall health.
• Medication adjustments, such as stopping blood thinners before surgery.

Procedure Description

1. The patient is placed under general anesthesia.
2. A small incision is made through the skin and fascia at a site separate from the spine.
3. A needle is inserted into the bone (commonly the pelvis) to aspirate bone marrow.
4. The extracted marrow is processed and prepared for grafting.
5. The bone marrow is then applied to the spinal fusion site to promote bone growth.
6. The incision site is closed with sutures or medical glue.

Tools and Equipment: Aspiration needle, syringe, processing equipment
Anesthesia: General anesthesia

Duration

The procedure typically takes around 20-40 minutes, depending on the complexity and patient's condition.

Setting

The procedure is performed in a hospital or a specialized surgical center under sterile conditions.

Personnel

• Orthopedic or spinal surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection at the aspiration or surgical site
• Bleeding or hematoma formation
• Pain at the aspiration site
• Rare complication of injury to adjacent structures
• Delayed wound healing

Management of these risks involves antibiotics, pain management, and close monitoring during the recovery period.

Benefits

• Enhanced bone healing and fusion
• Reduced risk of non-union (failure to heal) in spinal fusion
• Utilizes patient's tissue, reducing the risk of rejection

Patients may begin to see benefits and improved stability within a few months post-surgery, although complete healing can take around 6-12 months.

Recovery

• Initial recovery in the hospital for 1-3 days
• Pain management with medications
• Instructions on wound care for the incision site
• Gradual return to normal activities over 6-8 weeks
• Follow-up appointments for imaging and physical assessments

Alternatives

• Synthetic bone graft materials
• Donor bone grafts (allografts)
• Minimally invasive spine surgery without bone grafting
• Non-surgical management like physical therapy and medication

Each alternative has its own advantages and risks; for example, synthetic grafts may eliminate donor site complications but might not integrate as well as autografts.

Patient Experience

During the procedure, the patient will be under general anesthesia and not feel any pain. Post-procedure, there may be discomfort and pain at the incision and aspiration sites, managed with pain medication. Full recovery may involve physical therapy and gradual resumption of normal activities.

Pain management and comfort measures will include prescribed pain medications, ice packs to reduce swelling, and specific instructions for mobility and physical activity limits.