An evaluation of biomaterials and osteobiologics for arthrodesis achievement in spine surgery

Yoo, Joon S; Ahn, Junyoung; Patel, Dillon S.; Hrynewycz, Nadia M; Brundage, Thomas S; Singh, Kern

doi:10.21037/atm.2019.06.80

Cited by 13 publications

(10 citation statements)

References 51 publications

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“…However, in the clinical studies, the results were evaluated by the rate of fusion and implant failure after at least 2 years of follow-up. Fusion involves complicated processes, including stability, bone quality, graft type/gap, aging, and decortication techniques, [28][29][30][31] and cross-links play only a minor role in stability. Second, there are differences in spinal mobility between quadrupeds and humans.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical Comparison of Different Numbers and Configurations of Cross-Links in Long-Segment Spinal Fixation—An Experimental Study in a Porcine Model

Hsieh

Liu

Tsai

et al. 2021

Global Spine Journal

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Study Design: Biomechanical study. Objective: Cross-links are a type of common clinical spinal instrumentation. However, the effects of the position and number of cross-links have never been investigated in long-segment spinal fixation, and the variables have not been optimized. We conducted an in vitro biomechanical study by using a porcine long-segment spinal model with 5 different crosslink configurations to determine the optimal construct for clinical practice. Methods: Five modalities with paired segmental screws from T15-L5 were tested in 20 porcine spines. The spines without cross-links composed the control group, Group A; those with a single cross-link from L2-3 composed Group B; those with 2 cross-links from L1-2 and L3-4 composed Group C; those with 2 cross-links from T15-L1 and L4-5 composed Group D; and those with 3 cross-links from T15-L1, L2-3 and L4-5 composed Group E. Spinal stiffnesses in flexion, extension, lateral bending, and axial rotation were compared among 5 different cross-link configurations in 5-level porcine spinal units. Results: Flexional, extensional and lateral bending stiffnesses did not significantly change with an increasing number of cross-links or positions in the construct. Axial stiffness was significantly increased with 2 cross-links compared to one ( P < 0.05) and with placement more distant from the center of the long spinal fixation construct ( P < 0.05). Conclusions: Two cross-links individually placed proximal and distal from the center of a construct is an optimal and efficient configuration to achieve biomechanical stability in non-rigid lumbar spines undergoing long-level fixation.

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Section: Discussionmentioning

confidence: 99%

Biomechanical Comparison of Different Numbers and Configurations of Cross-Links in Long-Segment Spinal Fixation—An Experimental Study in a Porcine Model

Hsieh

Liu

Tsai

et al. 2021

Global Spine Journal

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“…This indicates that Endo-TLIF could have a good fusion rate. Before the experiment, we were concerned about the possibility of low fusion rate due to more allografts and very little amount of autografts were implanted in the Endo-TLIF group and the osteogenic capacity of allograft may weaker than autologous bone in the MIS-TLIF group [24]. Studies have shown high fusion rates were appeared in MIS-TLIF, such as 88.9% at postoperative 1 year and 96.0% at postoperative 3 years [8,25].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Versus Minimally Invasive Transforaminal Lumbar Interbody Fusion In 1-Segment Lumbar Spondylolisthesis: A Prospective Randomised Pilot Study

Chen

Qin

et al. 2021

Preprint

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Background: There are currently several minimally invasive techniques for lumbar spine interbody fusion that have been shown to minimize surgical and perioperative morbidity. We aimed to evaluate the curative efficacy of endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) by comparing perioperative characteristics and 1.5-year observational outcomes in 1-segment lumbar spondylolisthesis between the minimally invasive TLIF (MIS-TLIF) technique and the optimized Endo-TLIF technique. Methods: One hundred and two patients treated by MIS-TLIF (48 cases) or Endo-TLIF (54 cases) were included from March 2018 to April 2019. Perioperative parameters and clinical outcomes were evaluated. Inflammatory biomarkers were measured for postoperative traumatic stress and muscle injury. Fusion rates were determined at 18 months after surgery by CT.Results: The Endo-TLIF group had similar incision length, return to work time and rate (p>0.05). Blood loss, left bed time and analgesic ratio were significantly less in Endo-TLIF group (p<0.05). The Endo-TLIF group had a significantly longer operative and radiation exposure time compared with MIS-TLIF group (p<0.05). The CRP and ESR levels were lower in the Endo-TLIF group compared with the MIS-TLIF group (p<0.05). The VAS and ODI improved significantly in both groups after surgery. Significant decreases in low back VAS in the Endo-TLIF group were found at postoperative day 1 and 3 months after surgery (p<0.05). The fusion rate in the Endo-TLIF group (90.7%) was similar to that in the MIS-TLIF group (95.8%).Conclusions: Endo-TLIF has comparable perioperative analysis and clinical outcomes in comparison to MIS-TLIF and manifests a greater improvement in less multifidus muscle damage, inflammation and faster patient recovery. Thus, Endo-TLIF should be considered as a feasible and effective technique for 1-segment lumbar spondylolisthesis patients with similar fusion rate.Trial registration: ChiCTR1800015197, 13 March 2018. Trial registry: Chinese Clinical Trial Registry. Registered 13 March 2018. http://www.chictr.org.cn/showproj.aspx?proj=25865

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“…Autografts remain the gold standard material, displaying successful fusion rates in the treatment of degenerative lumbar disorders. However, procuring too many autogenic bone grafts may result in donor site morbidities, especially resulting in pain or infection [ 5 , 15 , 16 ]. The use of other alternative osteobiologics in spine surgery is believed to improve pain, fusion rates, and clinical outcomes [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…9 An increasing variety of osteobiologic materials, including autologous and allogenic bone grafts, bone marrow aspirate, demineralized bone matrix (DBM), ceramics, and growth factors are available to the spine surgeon. 5,7,15 Autografts remain the gold standard material, displaying successful fusion rates in the treatment of degenerative lumbar disorders. However, procuring too many autogenic bone grafts may result in donor site morbidities, especially resulting in pain or infection.…”

Section: Introductionmentioning

confidence: 99%

Fusion Assessment of Oblique Lumbar Interbody Fusion Using Demineralized Bone Matrix: A 2-Year Prospective Study

Lee,

Jung,

Lee

et al. 2023

Neurospine

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Objective: Although several studies have reported successful fusion rates after oblique lumbar interbody fusion (OLIF) using allografts or dimerized bone matrix (DBM) instead of autografts, whether OLIF can achieve satisfactory solid fusion without the use of autografts remains unclear. This study investigated the real fusion rates after OLIF using allografts and DBM, which were evaluated using both dynamic radiographs and computed tomography scans.Methods: We enrolled 79 consecutive patients who underwent minimally invasive OLIF followed by percutaneous pedicle screw fixation. All patients were treated with OLIF between L2 and L5 and underwent radiographic and clinical follow-ups at 12, 18, and 24 months after surgery. Radiographic assessment of fusion was performed using the modified BrantigaSteffee-Fraser (mBSF) scale, which was categorized as follows: grades I (radiographic pseudoarthrosis), II (indeterminate fusion), and III (solid radiographic fusion). Other radiologic and clinical outcomes were evaluated using the following parameters: vertebral slippage distance, disc height, subsidence, Oswestry Disability Index (ODI), and visual analogue scale (VAS).Results: Clinical outcomes demonstrated significant improvements in the VAS scores for back pain, leg pain, and ODI after surgery. Subsidence was present in 34 cases (35.4%) at 12 months postoperatively, which increased to 47.9% and reached 50.0% at 1.5 years and 2 years after surgery, respectively. The solid fusion rate after OLIF was 32.3% at 1 year, increased to 58.3% at 1.5 years, and reached 72.9% at 2 years. Radiographic pseudoarthrosis was 24.0% at 1 year, which decreased to 6.3% at 1.5 years and 3.1% at 2 years.Conclusion: OLIF is a safe and effective surgical procedure for the treatment of degenerative lumbar diseases. The mBSF scale, which simultaneously evaluates both dynamic angles and bone bridge formation, offers great reliability for the radiological assessment of fusion. Moreover, OLIF using allografts and DBM, which is performed on one or 2 levels at L2–5, can achieve satisfactory fusion rates within 2 years after surgery.

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An evaluation of biomaterials and osteobiologics for arthrodesis achievement in spine surgery

Cited by 13 publications

References 51 publications

Biomechanical Comparison of Different Numbers and Configurations of Cross-Links in Long-Segment Spinal Fixation—An Experimental Study in a Porcine Model

Biomechanical Comparison of Different Numbers and Configurations of Cross-Links in Long-Segment Spinal Fixation—An Experimental Study in a Porcine Model

Endoscopic Versus Minimally Invasive Transforaminal Lumbar Interbody Fusion In 1-Segment Lumbar Spondylolisthesis: A Prospective Randomised Pilot Study

Fusion Assessment of Oblique Lumbar Interbody Fusion Using Demineralized Bone Matrix: A 2-Year Prospective Study

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