Allograft Versus Demineralized Bone Matrix in Instrumented and Noninstrumented Lumbar Fusion: A Systematic Review

Abstract

Study Design:Systematic review.Objectives:The aim was to determine the fusion efficacy of allograft and demineralized bone matrix (DBM) in lumbar instrumented and noninstrumented fusion procedures for degenerative lumbar disorders.Methods:A literature search was conducted using the PubMed and Cochrane databases. To be considered, publications had to meet 4 criteria: patients were treated for a degenerative lumbar disorder, a minimum group size of 10 patients, use of allograft or DBM, and at least a 2-year follow-up. Data on the study population, follow-up time, surgery type, grafting material, fusion rates, and its definition were collected.Results:The search yielded 692 citations with 17 studies meeting the criteria including 4 retrospective and 13 prospective studies. Six studies used DBM and 11 employed allograft alone or in the combination with autograft. For the allograft, fusion rates ranged from 58% to 68% for noninstrumented and from 68% to 98% for instrumented procedures. For DBM, fusion rates were 83% for noninstrumented and between 60% and 100% for instrumented lumbar fusion procedures.Conclusions:Both allograft and DBM appeared to provide similar fusion rates in instrumented fusions. On the other hand, in noninstrumented procedures DBM was superior. However, a large variation in the type of surgery, outcomes collection, lack of control groups, and follow-up time prevented any significant conclusions. Thus, studies comparing the performance of allograft and DBM to adequate controls in large, well-defined patient populations and with a sufficient follow-up time are needed to establish the efficacy of these materials as adjuncts to fusion.

Comparison of synthetic bone graft ABM/P-15 and allograft on uninstrumented posterior lumbar spine fusion in sheep

“…There are no previous studies that have used ABM/P-15 in this challenging PLF model. The use of ABM/P-15 in this study was comparable with clinical settings and the clinical use of graft material, and is therefore highly clinically relevant [5, 6].…”

“…Spinal fusion is a procedure where bone graft material is used to facilitate novel bone formation between two adjacent vertebral bones. The aim of fusion is to segmentally impair movement and stabilization, and the procedure may be performed with or without instrumentation [5, 6]. Many different approaches have been tried, and posterior, anterior, and interbody fusion between vertebral bodies are commonly used [7, 8].…”

Bone regeneration in Ds-Red pig calvarial defect using allogenic transplantation of EGFP-pMSCs – a comparison of host cells and seeding cells in the scaffold

“…Allografts may provide the same osteoconductive conduits for bony fusion as traditional autografts and may have comparable biomechanical properties [5, 6]. Although depleted of osteoprogenitor cells like MSCs, the fusion rate still reaches 73% to 100% in instrumented spinal fusion [7-16], making allografts a clinically feasible alternative for fusion. Cells, scaffolds, and factors are the triad of regenerative engineering, and the lack of one of these three graft properties made us wonder about the role of seeded cells in bone regeneration.…”

Current Trends in the Development of Materials for Bone Grafting and Spinal Fusion (Review)

“…Bone matrix is obtained by demineralization of bone tissue so that only an insignificant amount of calcified substances remain; this material is rich in type 1 collagen and growth factors [45]. The data on the efficacy of DBM in spinal surgery still vary due to its heterogeneity, especially with regard to the activity of growth factors [45,46]. The advantages of DBM are sterility and low antigenicity [47][48][49].…”