Cervical degenerative disc disease (CDDD) can lead to radiculopathy and myelopathy, resulting in pain, lack of function, and immobility. Anterior cervical discectomy and fusion (ACDF) is a common surgical treatment modality for advanced CDDD. ACDF involves removal of the affected disc(s) followed by replacement with a bone or synthetic graft. Historically, autograft has been considered the gold standard for interbody fusion. However, it is often associated with limitations, including donor site morbidity and limited quality and supply, prompting surgeons to seek alternatives. Two of the most common alternatives are structural bone allografts and polyetheretherketone (PEEK) synthetic cages. Both, advantageously, have similar mechanical properties to autologous bone, with comparable elastic modulus values. However, a lack of osseointegration of PEEK cages has been reported both pre-clinically and clinically. Reported fusion rates assessed radiographically are higher with the use of structural bone allografts compared to PEEK cages, while having a lower incidence of pseudarthrosis. This book chapter will discuss in detail the pre-clinical and clinical performance of structural allografts in comparison to conventional PEEK cages.

Demineralized bone matrices (DBMs) have been used in a wide variety of clinical applications involving bone repair. Ideally, DBMs should provide osteoinductive and osteoconductive properties, while offering versatile handling capabilities. With this, a novel fiber technology, LifeNet Health-Moldable Demineralized Fibers (L-MDF), was recently developed. Human cortical bone was milled and demineralized to produce L-MDF. Subsequently, the fibers were lyophilized and terminally sterilized using low-dose and low-temperature gamma irradiation. Using L929 mouse fibroblasts, L-MDF underwent cytotoxicity testing to confirm lack of a cytotoxic response. An alamarBlue assay and scanning electron microscopy demonstrated L-MDF supported the cellular function and attachment of bone-marrow mesenchymal stem cells (BM-MSCs). Using an enzyme-linked immunosorbent assay, L-MDF demonstrated BMP-2 and 7 levels similar to those reported in the literature. In vivo data from an athymic mouse model implanted with L-MDF demonstrated the formation of new bone elements and blood vessels. This study showed that L-MDF have the necessary characteristics of a bone void filler to treat osseous defects.