Minimally Invasive Bone Grafts: Requirements, Methods, and Use

It is important to understand that minimally invasive bone grafting can only be done effectively in a limited number of situations. Not all fractures or bone grafts can be performed, or should be performed, using minimally invasive injection techniques. Each clinical situation must be considered carefully to make sure that a minimally invasive approach will fulfill all of the necessary requirements for successful grafting.

There are three primary requirements, if minimally invasive methods are to be used:

1) It must be possible to place and then hold the bone in an optimal alignment without open surgery. This may require manipulation of the site while under an anesthetic and use of a cast or brace.

2) Tissues that might prevent bone healing must not be present in the graft site.

3) There must be space available for the injected material in the graft site. Sometimes space for the graft can be made using a needle or small instrument that does not require a surgical incision.

Bone Grafting
Bone grafting, as the term is generally used, refers to a wide variety of surgical methods augmenting or stimulating the formation of new bone where it is needed.

There are four broad clinical situations in which bone grafting is performed:

1) To stimulate healing of fractures either fresh fractures or fractures that have failed to heal after an initial treatment attempt.

2) To stimulate healing between two bones across a diseased joint. This situation is called "arthrodesis" or "fusion".

3) To regenerate bone which is lost or missing as a result of trauma, infection, or disease. Settings requiring reconstruction or repair of missing bone can vary from filling small cavities, to replacing large segments of bone 12 or more inches in length.

4) To improve the bone healing response and regeneration of bone tissue around surgically implanted devices, such as artificial joints replacements (e.g. total hip replacement or total knee replacement) or plates and screws used to hold bone alignment.

All methods of bone grafting involve adding some material to the specific site where bone is needed as a means of stimulating a new or more effective bone healing response. In some settings, there is now minimally invasive bone grafting, meaning that the grafting can be performed with a needle, without a surgical incision. However, most methods require open implantation. This is necessary to insure that there is adequate space and proper positioning of the graft material. It is also necessary to remove scar tissues and dead or poorly vascularized tissues from the graft site, since this would interfere with the healing process.