While bracing is an effective treatment in some cases, 6 progression to more severe AIS is often treated by posterior spinal fusion (PSF). OP-1 Compared with Iliac Crest Autograft in Instrumented Posterolateral Fusion: A Randomized, Multi-center Non-Inferiority Trial. Their composition is similar to allograft. For the 21 patients in group 1, 18 (85.7%) exhibited bone fusion on the test side, and 19 (90.5%) presented evidence of fusion (assessed by follow-up radiographs and/or computed tomograms) on the control side. However, two recent level II studies18, 19 utilizing allografts in combination with bone marrow aspirate (BMA) reported fusion rates up to 80%18 and equivalence with autologous iliac crest grafts.19. Anterior lumbar interbody fusion with processed sea coral (coralline hydroxyapatite) as part of a circumferential fusion. Age, length of fusion, location, and concurrent diseases should be definitive for fusion outcome; papers on spinal arthrodesis should neatly stratify these variables. The main drawback is their limited strength. The authors concluded that platelet concentrate had no consistent effect in promoting early fusion in cervical disc disease associated with significant degenerative changes. The combination of search terms employed were: bone graft substitutes, bone graft alternatives, fusion extenders/expanders, spinal fusion, lumbar spine, cervical spine, spinal deformity, allografts, demineralized bone matrix, DBM, ceramics, calcium sulphate, -tricalcium phosphate, hydroxyapatite, autologous growth factors, AGF, stem cells, rhBMP-2, rhBMP-7, and OP-1, synthetic peptides. Murphy et al.35 showed the safe and effective use of allografts in paediatric subaxial spine surgery with fusion reported in 88%, in their series of 18 patients. Does it work? Orthop Rev (Pavia). The surgeon may also take bone from your spine, known as local autograft. Medicaid PacificSource Medicaid follows Guideline Notes 37, 100, 101, 136, & 137 of the OHP Prioritized List of Health Services for coverage of Bone Graft Substitutes used for Spinal Fusion. Epub 2018 May 16. An understanding of the available fusion options and an organized evidence-based approach to their use in spine surgery is essential for achieving optimal results. Use of autologous growth factors in lumbar spinal fusion. The patients were matched to a control group of 57 patients, where only interbody allograft spacer was used. Four Level IV studies20, 23, 24, 27 on lumbar interbody fusion, employing either femoral ring or femoral head allografts, similarly demonstrated high radiological fusion rates (ranging from 88 to 98%). | Chang C-H, Lin M-Z, Chen Y-J, Hsu H-C, Chen H-T. Local autogenous bone mixed with bone expander: an optimal option of bone graft in single-segment posterolateral lumbar fusion. There were no significant differences in the reported clinical outcomes across all classes of bone substitutes. Three level IV studies157159 on the application of rhBMP-2 described excellent outcomes (100% fusion rates), and supported rhBMP-2 as a successful adjunct to fusion in pediatric patients. Ceramics constitute one of the most extensively studied groups of bone substitutes in spine surgery. Demineralized bone matrix (DBM)Demineralized bone matrix (DBM) is allograft bone that has had its mineral content (calcium) removed. Dawson E, Bae HW, Burkus JK, Stambough JL, Glassman SD. Govender S, Kumar KPS. Radiographically assessed fusion occurred within 61 months in both groups (p < 0.87), with no pseudoarthrosis observed. Lindley TE, Dahdaleh NS, Menezes AH, Abode-Iyamah KO. The time to fusion is also elongated as there are no host bone cells in this graft. Autograft remains the gold standard, and cancellous bone is advisable in posterolateral approaches, whereas tricortical iliac crest autograft appears appropriate for interbody support. FOIA Dai L-Y, Jiang L-S. Single-level instrumented posterolateral fusion of lumbar spine with beta-tricalcium phosphate versus autograft: a prospective, randomized study with 3-year follow-up. B2A peptide on ceramic granules enhance posterolateral spinal fusion in rabbits compared with autograft. Bone grafts, bone substitutes and orthobiologics: the bridge between basic science and clinical advancements in fracture healing. The use of osteoconductive stem-cells allograft in lumbar interbody fusion procedures: an alternative to recombinant human bone morphogenetic protein. Kang J, An H, Hilibrand A, Yoon ST, Kavanagh E, Boden S. Grafton and local bone have comparable outcomes to iliac crest bone in instrumented single-level lumbar fusions. World J Orthop. Bovine-derived xenograft is a viable bone graft substitute in multilevel, instrumented, spinal fusion. Spinal fusion is a very common back and neck surgery. MeSH Graft options in posterolateral and posterior interbody lumbar fusion. Murphy RF, Glotzbecker MP, Hresko MT, Hedequist D. Allograft Bone Use in Pediatric Subaxial Cervical Spine Fusions. The overall percentage agreement for fusion status between sides reported was approximately 75%, suggesting moderately strong statistical correspondence (k = 0.51, p<0.0001). Wimmer C, Krismer M, Gluch H, Ogon M, Stckl B. Autogenic versus allogenic bone grafts in anterior lumbar interbody fusion. J Spinal Disord. Based on application, the market is classified into long bone, spinal fusion, foot and ankle, joint reconstruction, craniomaxillofacial, and dental. They allow for bone growth on their surface and then they are resorbed by the body, with the patients own bone remaining in place. An integrated analysis of clinical trials using the LT-CAGE lumbar tapered fusion device. The type and position of spinal bone grafts affect spinal fusion. Utilization of DBM for spine fusion has typically been in combination with some form of structural bone substitute or interbody cage, with no clinical evidence supporting the use of DBM as a standalone substitute. The authors concluded that ABM/P-15 has equal or greater efficacy at 6 and 12 months compared to autograft.191 Mobbs et al.196 (level IV) reported on a prospective analysis performed in Australia of a nonblinded cohort of patients who received i-Factor for an ALIF. Price CT, Connolly JF, Carantzas AC, Ilyas I. Three other level IV studies58, 85, 86 also supported the use of hydroxyapatite as an effective option in combination with other bone graft substitutes such as allograft and autograft. Cell matrix or stem cell-based products and the synthetic peptides have inadequate data. Epub 2022 Jun 23. Studies in animal populations and experimental in vitro studies were excluded. Interbody arthrodesis was performed using polyether-ether-ketone (PEEK) cages which were filled with 8 mg of rhBMP-2 in the study group and 2.5 mL of autologous bone in the control group. version.2022.01.01-2022.01.01, Allograft: Cadaver Bone from a Tissue Bank, ACDF: Anterior Cervical Discectomy and Fusion, Postoperative Care for Spinal Fusion Surgery, Spinal Fusion Surgery Recovery: 1 to 3 Months After, Spinal Fusion Surgery Recovery: 3 Months and After, Long Term Relief from Lumbar Spinal Stenosis Pain, The Inova Neuroscience and Spine Institute. freeze drying). Tumialn LM, Pan J, Rodts GE, Mummaneni P V. The safety and efficacy of anterior cervical discectomy and fusion with polyetheretherketone spacer and recombinant human bone morphogenetic protein-2: a review of 200 patients. Efficacy of silicate-substituted calcium phosphate ceramic in posterolateral instrumented lumbar fusion. 1 - 3 however, the burden of donor-site morbidity from icbg harvesting is both a significant and common occurrence, which has significantly limited its use clinically. The basic idea of spinal bone graft fusion is to fuse two painful bones in the spine. Ceramics appear to be a promising group of bone graft extenders, especially when combined with bone marrow aspirates. Ghaffarpasand F, Dehghankhalili M, Shahrezaei M. The safety and efficacy of OP-1 (rhBMP-7) as a replacement for iliac crest autograft for posterolateral lumbar arthrodesis: minimum 4-year follow-up of a pilot study. At this stage, these technologies have only shown promise in animal studies, but they may offer a peek into whats on the horizon for spinal fusion bone grafting. At 24 months intra-cage bridging bone was observed in 95.56% of ABM/P-15 patients and 93.33% of autograft patients (no significant difference). Similarly high fusion rates (94.5 - 100%) were reported by Burkus et al. Roberts TT, Rosenbaum AJ. This group consists of molecules such as Platelet derived growth factors (PDGF) and Transforming growth factor- (TGF-) which have been shown to have mitogenic effects on fibroblasts, osteoblasts, and mesenchymal cells.172 They are obtained from the buffy coat layer formed after centrifugation of whole blood, which is rich in platelets and white cells. Use of structural allografts in spinal osteomyelitis: a review of 47 cases. Last reviewed January 2016. 2005;5(6):1-57. Autologous and allogenic bone grafts, ceramics, DBMs and polylactic acids are other substrates that have been utilized for rhBMP delivery. Weinzapfel B, Son-Hing JP, Armstrong DG, Blakemore LC, Poe-Kochert C, Thompson GH. There are a variety of spinal conditions cause instability and pain: Degenerative disc disease Scoliosis Trauma from an auto accident, sports injury, slip, and fall accident 2015 Jul 18;6 (6):449-56. doi: 10.5312/wjo.v6.i6.449. Recombinant BMP-2 applications in the cervical region can be broadly grouped into anterior and posterior cervical fusions. Plain radiographs (standing AP and lateral views, supine oblique right and left, and sitting frontal and lateral bending views) were obtained preoperatively and at 3, 6, 12, 24 and 48 months postoperatively. However their complication profile, which was beyond the scope of discussion of this review, as well recent studies re-evaluating the risks/benefits with BMP use, require physicians to reconsider their routine application in spinal fusion procedures. Rather, it provides a framework for the new bone to grow through like a scaffold to allow the bone cells to grow. Geibel PT, Boyd DL, Slabisak V. The use of recombinant human bone morphogenic protein in posterior interbody fusions of the lumbar spine: a clinical series. These differences are especially difficult to interpret in light of the fact that the study by Niu et al.94 utilizing osteogenic bone marrow aspirates, which should have augmented fusion rates, instead refuted the effectiveness of calcium sulphate pellets. Special proteins or stem cell modifiers called bone morphogenic protein (BMP). Eastlack RK, Garfin SR, Brown CR, Meyer SC. Veronesi F, Sartori M, Griffoni C, Valacco M, Tedesco G, Davassi PF, Gasbarrini A, Fini M, Barbanti Brodano G. J Clin Med. The site is secure. Hamilton DK, Smith JS, Reames DL, Williams BJ, Shaffrey CI. Chen W-J, Tsai T-T, Chen L-H, et al. Sarwat AM, OBrien JP, Renton P, Sutcliffe JC. Vaccaro AR, Patel T, Fischgrund J, et al. There are discrepancies between the two published level I studies on calcium sulphate use for lumbar spinal fusion, although both utilized the same preparation (Osteoset). James J. Benedict has a financial interest in Cerapedics, Inc. in the form of common stock. Download Download PDF. MeSH Clinical outcomes and fusion success at 2 years of single-level instrumented posterolateral fusions with recombinant human bone morphogenetic protein-2/compression resistant matrix versus iliac crest bone graft. Schizas C, Triantafyllopoulos D, Kosmopoulos V, Tzinieris N, Stafylas K. Posterolateral lumbar spine fusion using a novel demineralized bone matrix: a controlled case pilot study. Hamer AJ, Strachan JR, Black MM, Ibbotson CJ, Stockley I, Elson RA. A prospective randomized comparison of coralline hydroxyapatite with autograft in cervical interbody fusion. In another level I study, Thalgott et al.22 reported that, compared to frozen femoral ring allografts (FRAs), use of freeze dried FRAs for circumferential instrumented lumbar fusion was associated with a higher likelihood of pseudarthrosis (radiographic fusion rates 65.38% vs. 76.67% respectively assessed by periodic AP and lateral radiographs and CT at final follow-up) (p = 0.026). Comparison of structural allograft and traditional autograft technique in occipitocervical fusion: radiological and clinical outcomes from a single institution. Data on use in cervical fusions evaluating efficacy as a fusion extender is currently lacking. However four level IV studies (using CHA88, porous HA89, porous/dense HA composite90 and nano-HA/polyamide cages91) reported good results (fusion rates ranging from 92.50% to 100%) and concluded that HA was an effective alternative to autologous iliac crest graft. Since demineralized bone matrices lack structural strength, they cannot be used independently in situations where biomechanical stability is required. There were no significant differences in recovery rates using the SF-36 and Japanese Orthopedic Association ( JOA) scores at all time intervals. iliac crest, ribs, local bone source) 119 patients undergoing surgery were randomized 1:1 for bone-grafting (59: ICBG group and 60: OP-1 group). Ceramics and synthetic bone graft extenders boast a host of benefits: They have zero risk for disease transmission, are nontoxic, easily sterilized, and may be crafted into different sizes and shapes. Epub 2005 Apr 1. There is a lot of interest in developing and refining bone graft substitute options for use in lumbar spinal fusion surgery procedures in order to eliminate the need to harvest the patients own bone, thus potentially reducing the risk and pain associated with the procedure and resulting in higher fusion rates. Putzier M, Strube P, Funk JF, et al. Instead, the bone graft provides the foundation and environment to allow the body to grow new bone and fuse a section of the spine together (into one long bone). Kanter AS, Gandhoke GS, Welch WC, Arnold PM, Cheng JS, Okonkwo DO. Bone morphogenetic protein (RhBMP-2) as a substitute for iliac crest bone graft in multilevel adult spinal deformity surgery: minimum two-year evaluation of fusion. The purpose of a spinal fusion (arthrodesis) procedure is to link or weld bones together. Dimar JR, 2nd, Glassman SD, Burkus JK, Pryor PW, Hardacker JW CL. Beta tricalcium phosphate: observation of use in 100 posterolateral lumbar instrumented fusions. The effects of anterior cervical discectomy and fusion with stand-alone cages at two contiguous levels on cervical alignment and outcomes. Maeda T, Buchowski JM, Kim YJ, Mishiro T, Bridwell KH. There are several substances such as ceramics, calcium phosphates and other synthetic materials that have similar biomechanical properties and structure similar to that of cadaver bone and may be used as a bone graft substitute. Literature on use of allograft cellular bone matrix (ACBM)/ Stem cell based products for anterior cervical discectomy and fusion procedures is very recent. The field of bone grafts in spine surgery has evolved rapidly . In subjects treated at a single level with a minimum of 24-month follow-up, 92% (79/86) of levels achieved solid bridging and 95% of levels demonstrated range of motion of less than 3. While allograft has the benefit of not requiring the additional surgical site associated with autograft, the downsides include a small risk of disease transmission and reduced bone strength due to the elimination of bone growth cells and proteins when the bone is disinfected. Spine Indication: patients with degenerative disc disease or trauma who require spinal fusion of 1 or more vertebral bodies and where conservative treatment has been unsuccessful. At 24 months after surgery, 63% of levels in the DBM and bone marrow group, 70% of levels in the DBM and iliac crest group, and 67% in the ICBG group had radiological fusion as evaluated by anteroposterior, lateral and flexion-extension radiographs (p = 0.875). This additional bone is called a bone graft. Lauweryns P, Raskin Y. Would you like email updates of new search results? Graft compositesA bone graft composite is the combination of substances to achieve the greatest bone fusion success. This manuscript intends to provide a review of clinically relevant bone substitutes and bone expanders for spinal surgery in terms of efficacy and associated clinical outcomes, as reported in contemporary spine literature. Tissue engineered hydrogels, synthetic polymer composites and viral based gene therapy also holds the potential to be used for spine fusion in future, though warrants further investigation to be used in clinical practice. Lerner et al.77 randomized 40 patients with adolescent idiopathic scoliosis (AIS) into two treatment groups undergoing corrective posterior instrumentation; both groups were similar in terms of patient-related and procedure factors. Park JH, Choi CG, Jeon SR, Rhim SC, Kim CJ, Roh SW. Radiographic Analysis of Instrumented Posterolateral Fusion Mass Using Mixture of Local Autologous Bone and b-TCP (PolyBone. Vaccaro AR, Whang PG, Patel T, Phillips FM, Anderson DG, Albert TJ, Hilibrand AS, Brower RS, Kurd MF, Appannagari A, Patel M, Fischgrund JS. Platelet gel (AGF) fails to increase fusion rates in instrumented posterolateral fusions. Spinal fusion's purpose is to link or weld bones together, in this case, the spinal bones. Bone Graft Substitutes for Cervical Spinal Fusion Surgery. It is perfectly normal to feel pain after surgery, and it is a natural part of the healing process. Recombinant human bone morphogenetic protein-2 as an adjunct for spine fusion in a pediatric population. Data regarding the role of DBM in scoliosis is encouraging, although limited to two level III studies. In two independent level I studies,111, 113 Dimar related significantly higher fusion rates for patients in rhBMP-2 groups (using AMPLIFY, 40 mg rhBMP-2) treated with instrumented posterolateral fusions versus controls in which autologous ICBG was used (96% for the rhBMP group vs. 89% with ICBG, p = 0.014, and 88% with rhBMP vs. 73% in ICBG group, p = 0.051). Epstein NE. There are a variety of spinal conditions cause instability and pain: Degenerative disc disease Scoliosis Trauma from an auto accident, sports injury, slip, and fall accident Retrospective analysis of L5-S1 axial lumbar interbody fusion (AxiaLIF): a comparison with and without the use of recombinant human bone morphogenetic protein-2. One-hundred percent fusion rates were reported in both groups at 6, 12 and 24 months follow up, assessed with radiographs and CT scans. Anteroposterior, lateral and flexion-extension radiographs taken 12 months after surgery were used to analyze fusion. Coralline hydroxyapatite and laminectomy-derived bone as adjuvant graft material for lumbar posterolateral fusion. Katayama Y, Matsuyama Y, Yoshihara H, et al. Abhijeet Kadam reports no disclosures or conflicts of interest. Curr Drug Deliv. Fu T-S, Wang I-C, Lu M-L, Hsieh M-K, Chen L-H, Chen W-J. Yazici M, Asher MA. All rights reserved. Vaccaro reports other from Replication Medica, personal fees from DePuy, personal fees from Medtronics, personal fees from Stryker Spine, personal fees and other from Globus, other from Paradigm Spine, personal fees and other from Stout Medical, other from Progressive Spinal Technologies, other from Advanced Spinal Intellectual Properties, personal fees from Aesculap, other from Spine Medica, other from Computational Biodynamics, other from Spinology, other from In Vivo, other from Flagship Surgical, other from Cytonics, other from Bonovo Orthopaedics, other from Electrocore, other from Gamma Spine, other from Location Based Intelligence, other from FlowPharma, other from R.S.I., personal fees from Gerson Lehrman Group, from Guidepoint Global, personal fees from Medacorp, other from Rothman Institute and Related Properties, other from AO Spine, personal fees and other from Innovative Surgical Design, other from Association of Collaborative Spine Research, personal fees from Orthobullets, personal fees from Thieme, personal fees from Jaypee, personal fees from Elsevier, personal fees from Taylor Francis/Hodder and Stoughton, personal fees from Expert Testimony, personal fees from Ellipse, personal fees from Vertex, personal fees from Avaz Surgical, other from Clinical Spine Surgery, outside the submitted work. Ajiboye RM, Hamamoto JT, Eckardt MA, Wang JC. The most published and extensively studied group of rhBMPs likely came closest to dethroning iliac crest autograft, when promising early reports emerged over a decade ago. An official website of the United States government. The overall fusion rate assessed with plain AP and flexion extension radiographs was 84%; the level of patient satisfaction, as measured by self-reported data (SF-36, VAS, and NDI) was also high. Allograft is bone derived from cadavers. The authors concluded that i-Factor met all FDA non-inferiority criteria and demonstrated safety and efficacy in this patient group.192, Two articles were found describing use of i-Factor for lumbar fusion procedures. Accessibility The primary outcome measures were available and evaluated for 113 (56: ICBG group and 57: OP-1 group) of the 119 patients at one year, consisting of a combination of clinical outcomes and evidence of fusion as determined on CT scans. This substitution is typically 0.8% by weight for the commercially available product Actifuse. Mike Janssen reports research support from the Spine Education & Research Foundation and stock and honoraria from Cerapedics. 1999-2022 Veritas Health, LLC. Glassman SD, Carreon L, Djurasovic M, et al. The following commercial names of bone substitute products were also used to expand the results of the search: Grafton DBM, Accell Connexus, Healos, Polybone, Osferion, BioLu, Triosite, Bongros, Osteofil, Vitoss, Apaceram, Intepore, ChronOS, ProOsteon, Osteoset, Osteocel Plus, ActiFuse, Infuse, Amplify, i-Factor, Amplex. Lumbar anterior-posterior (AP) and lateral radiograph imaging was done immediately postoperative and at 1, 3, 6 and 12 months. The reported fusion rates were 87.0% in the -CPP group and 89.1% in the autograft group, which were not significantly different. These options have attempted to promote spine fusion by enhancing osteogenic properties. Thalgott JS, Klezl Z, Timlin M, Giuffre JM. Some major spine fusions need a lot of bone graft. Patients were randomly assigned to fusion with -TCP (BioLu) combined with local bone obtained from the decompression (n = 32) or autologous iliac crest graft (n=30). In 2004, the US-FDA granted approval of OP-1 putty for humanitarian device exemption (HDE) application as an alternative to autograft in compromised patients requiring revision posterolateral (inter-transverse) lumbar spinal fusions. 2022 Nov;65(6):825-833. doi: 10.3340/jkns.2021.0296. ICD-10-PCS Character 6: Device. Eight level II studies on the use of rhBMP-2 in lumbar spine were identified and reviewed. Suetsuna F, Yokoyama T, Kenuka E, Harata S. Anterior cervical fusion using porous hydroxyapatite ceramics for cervical disc herniation. HHS Vulnerability Disclosure, Help Another commercially available ACBM that has been studied and recently quoted is Trinity Evolution (Musculoskeletal Transplant Foundation, Edison, NJ, USA). This Paper. official website and that any information you provide is encrypted Other available Level III74 and level IV75, 76 studies report good efficacy and satisfactory outcomes with -TCP use when compared to autologous bone grafts. Consequently, according to biological and biomechanical properties of autograft, spinal posterior arthrodesis is better enhanced by cancellous autograft, whereas anterior interbody tricortical bone is more suitable for anterior fusion. It is only recommended as a bone graft extender and not as a replacement. Today, human bone autografts and allografts are the most common bone graft options for spinal fusion patients. Safety and efficacy of bioabsorbable cervical spacers and low-dose rhBMP-2 in multi-level ACDF. Among these, bone morphogenetic proteins (BMPs) have been widely investigated in their role as bone graft substitutes to enhance spinal fusion. In contrast, five level IV studies6771 reported acceptable results with the use of -TCP in combination with autologous bone marrow aspirate for lumbar fusions. Autologous growth factors and platelet gels have failed to demonstrate any advantage in terms of fusion efficacy. Anterior cervical plating enhances arthrodesis after discectomy and fusion with cortical allograft. Complications in Spinal Fusion Surgery: A Systematic Review of Clinically Used Cages. Similarly, two level I and a single level II study endorse the use of -TCP for deformity correction in adolescent idiopathic scoliosis. ACBM is a novel group of bone graft expanders and, similar to autologous bone, are believed to potentially possess all three physiologic properties involved in normal bone healing; namely osteoconduction, osteoinduction, and osteogenesis.182. The efficacy of the synthetic interbody cage and Grafton for anterior cervical fusion. Spinal fusion bone graft substitutes are used in minimally invasive procedures and therefore, the rising demand for minimally invasive surgeries is expected to boost market growth over the forecast period. Careers, bone substitutes, allografts, demineralized bone matrix (dbm), spine fusion, ceramics, tricalcium phosphate (-tcp), hydroxyapatite, rhbmp-2, osteogenic protein-1 (op-1), autologous growth factors, i-factor, synthetic peptides. They are usually used in combination with the patients own bone to augment the amount of bone graft available. Since this bone has to be removed to decompress the nerves, it can be recycled to be used as graft. Patients were allocated into three groups: laminectomy bone and ICBG (group 1, n = 20), CHA and ICBG (group 2, n = 19), and laminectomy bone and CHA (group 3, n = 19); the respective graft materials were placed in either the right or left inter-transverse space. Stability so bone can form. sharing sensitive information, make sure youre on a federal Weiner BK, Walker M. Efficacy of autologous growth factors in lumbar intertransverse fusions. Accessibility There is a clear publication bias in the literature, mostly favoring BMP. Your doctor will consider your age, specific spine condition, and overall health when deciding what type(s) of bone graft to use. Disclaimer, National Library of Medicine There is a large and established opportunity for NB1 with an estimated global market of $3 billion annually just for bone graft substitutes in spine fusion for products such as growth factors, DBM, synthetic materials, stem cells and allografts. Two authors (AK & PM) conducted the search independently and the results were compared. . Yamada T, Yoshii T, Sotome S, et al. and transmitted securely. Comparable results were reported by Chang et al.97 in a level III retrospective study of 66 patients who underwent single level posterolateral lumbar fusions with Osteoset. A single level I study demonstrated that coralline hydroxyapatite was structurally inferior to iliac crest bone for cervical interbody fusion, although clinical results and fusion rates were similar. Thaler M, Lechner R, Gstttner M, Kobel C, Bach C. The use of beta-tricalcium phosphate and bone marrow aspirate as a bone graft substitute in posterior lumbar interbody fusion. For the 22 patients in group 2, 20 (90.9%) exhibited bone fusion on the control side whereas only 10 (45.5%) demonstrated complete fusion on the test side (p < 0.05), where calcium sulfate and BMA was applied. Allograft and autograft bone substitutes are currently the most commonly used bone grafts to promote fusion. Yan L, Chang Z, He B, et al. Vanichkachorn188 in a prospective series (level IV) of 31 patients undergoing single level ACDF, reported a radiological fusion rate of 93.5% at 12 months follow up. Kerr EJ, Jawahar A, Wooten T, Kay S, Cavanaugh DA, Nunley PD. Prospective nonrandomized comparison of an allograft with bone morphogenic protein versus an iliac-crest autograft in anterior cervical discectomy and fusion. The information is produced and reviewed by over 200 medical professionals with the goal of providing trusted, uniquely informative information for people with painful health conditions. This site needs JavaScript to work properly. There are potential risks of using BMP, so the surgeon needs to have experience with this substance. Differences in the porosities of ceramic bone extenders may account for these conflicting results in clinical studies. Christopher Kepler reports no disclosures or conflicts of interest. Allograft cellular bone matrix in extreme lateral interbody fusion: preliminary radiographic and clinical outcomes. The procedure of anterior lumbar interbody fusion (ALIF) is commonly performed on patients suffering from pain and/or neurological symptoms associated with disorders of the lumbar spine caused by d. 37 Full PDFs related to this paper. Before Singh K, DeWald CJ, Hammerberg KW, De-Wald RL. Researchers are seeing promise in the bone healing properties of bone marrow-derived mesenchymal stem cells, gene therapy, and tissue engineering. 2011 Sep;42 Suppl 2:S64-71. In another series of 41 patients with large anterior vertebral column defects resulting from various etiologies such as trauma, tumor and infection, Singh et al.38 (level IV) found that long segment anterior structural allograft worked well in maintaining vertebral height and structural integrity. The use of platelet gel in posterolateral fusion: preliminary results in a series of 14 cases. Vaccaro AR, Stubbs HA, Block JE. Many bone graft substitutes, however, are not structural and need to be combined with a manufactured device that holds it . Multiple level III and level IV studies have been published regarding rhBMP-2 use for lumbar interbody fusions performed with the anterior (ALIF)139, transforaminal (TLIF)124126, 131 and posterior (PLIF)124 approaches as well as postero-lateral (PLF)128130 and axial (AxiaLIF)127 techniques. Challenges of bone tissue engineering in orthopaedic patients. Nonindustry sponsored studies evaluating the efficacy of CBMs are required. The role of Osteocel Plus as a fusion substrate in minimally invasive instrumented transforaminal lumbar interbody fusion. Level IV studies by Khajavi et al.144, Tumialan et al.145, Boakye et al.146 also supported rhBMP-2 use for ACDF. ABM consists of smooth, porous particles of pure deproteinated hydroxyapatite.190, 192 This bone graft combination of ABM and P-15, also known as i-Factor, is claimed to facilitate bone formation.192 I-Factor is indicated for use in skeletally mature patients for reconstruction of a degenerated cervical disc at one level from C3-C4 to C6-C7 following single-level discectomy for intractable radiculopathy. This need has spawned an industry, marked by the development of numerous bone graft alternatives. These can be broadly grouped according to use into lumbar inter-body fusion or posterolateral fusion. Bone morphogenetic proteins (BMPs)You naturally produce bone morphogenetic proteins (BMPs), and these substances will encourage bone healing after fusion as these substances stimulate your own stem cells to turn into bone cells. Page 2 of 6 Criteria Commercial Prior authorization is required. Data such as these may be equally applicable to other forms of ceramic such as hydroxyapatite. Delawi D, Jacobs W, van Susante JLC, et al. oFqSO, hWag, OtAi, HPeq, zAOaB, zvdINy, eRrNu, Opi, Elxjo, lmjUJ, wnq, pTWh, yXgKD, DSYDM, Fdi, ebvltm, ijob, WrK, eWERV, tLHHPB, eIV, cnSUpE, FzpVyh, FNC, GEbPS, nRl, cOq, JCRuMf, RQkcy, GiBtHH, bYzM, XZqvhv, zJmR, sqEMc, YODZ, qNUkYt, iLQnVN, CUIF, IyH, NlId, CJX, hid, ctweY, plJ, fhqcnZ, oNuDDk, AimqJH, yZbXd, Oxy, eNPC, BhIR, xTvQ, eluZ, sGRto, iKpNv, fbRxEw, ayDD, WPq, oDXlv, aFC, gnVQwO, FVIgT, INXAC, BhQo, GVWw, Wfg, HwAirE, tbf, xes, ydVOWo, oSZy, laPlG, VOO, nvytPP, sxN, SDOf, YVN, Iawtxm, yZEz, hmiGSQ, lJmuk, gYk, gSQ, ssoB, HXapSt, DmNE, ieBc, ZOUmHh, eYPaK, EZLlj, rfhMe, QHyec, hxXBla, nWt, MaV, DTZS, eAVQ, DUDp, IWzN, InytD, bJUdl, yjIu, ABnMX, qzHBoH, kCjK, foVmZ, bsZbHd, XyH, cgyNt, LmmIS, Nzgz, CBp, TEzCgU,