Augmenting Local Bone With Grafton Demineralized Bone Matrix for Posterolateral Lumbar Spine Fusion: Avoiding Second Site Autologous Bone Harvest

Sassard, Walter R.; Eidman, Dan K.; Gray, Paul Milton; Block, Jon E.; Russo, Richard E.; Russell, James L.; Taboada, Elma M

doi:10.3928/0147-7447-20001001-17

Cited by 111 publications

(25 citation statements)

References 19 publications

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“…Six studies on DBM, 1 noninstrumented 53 and 5 instrumented, 9,54 -57 were included in this review. Five (4 prospective and 1 retrospective) studies looked at DBM in posterior fusion, 9,53 -56 and one prospective study utilized DBM for both anterior and posterior procedures. 57…”

Section: Resultsmentioning

confidence: 99%

“…Three studies, 2 prospective and 1 retrospective, utilized a combination of DBM and autograft in PLF/PLIF, TLIF, or ALIF procedures. 55 -57 In a prospective case-control study, 56 patients underwent PLF or PLF/PLIF with Grafton DBM and local autograft, and 52 patients received ICBG. 55 At 24 months, the results showed a 60% fusion rate in the DBM and a 56% fusion rate in the control group (Tables 2 and 3).…”

Section: Resultsmentioning

confidence: 99%

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

Buser

Brodke

Youssef

et al. 2017

Global Spine Journal

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

Buser

Brodke

Youssef

et al. 2017

Global Spine Journal

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“…There is a study somewhat encouraging, which compared the fusion rates of auto-local bone and DBM constructs to that of the auto-iliac bone alone cases in the setting of PLF. The result that presented no difference between the two groups indicated that it has a value as a graft extender in humans [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, we concluded that it does not indicate inconsistent osteoinductivity, but unwarrantable osteoinductivity. Sassard et al [ 21 ] reported that DBM acted as a graft extender when it was mixed with auto-iliac bone in 3:1 ratio. In my opinion, that cannot be as an osteoinductive material.…”

Section: Discussionmentioning

confidence: 99%

Demineralized Bone Matrix, as a Graft Enhancer of Auto-Local Bone in Posterior Lumbar Interbody Fusion

Ahn¹,

Moon²,

Kim³

et al. 2014

Asian Spine J

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Study DesignA case controlled study with prospective data collection.PurposeTo evaluate the early influence and the final consequence of demineralized bone matrix (DBM) on auto-local bone as a graft enhancer in posterior lumbar interbody fusion (PLIF).Overview of LiteratureDBM is known as an osteoinductive material; however, it has not been clearly recognized to enhance auto-local bone with a small amount.MethodsPatients who had a PLIF were allocated into two groups. Group I (70 cases) used auto-local bone chips and group II (44 cases) used DBM as an additive to auto-local bone, 1 mL per a segment. Group selection was alternated. Early assessment was performed by computed tomography at 6 months and final assessment was done by simple radiography after 24 months at least. The degree of bone formation was assessed by 4 grade scale.ResultsThe subjects of both groups were homogenous and had similar Oswestry Disability Index at final assessment. The ratio of auto-local bone chips and DBM was 6:1. The degree of bone formation at 6 months after surgery was superior in group II. However, there was no significant difference between the two groups at the final assessment.ConclusionsDBM was not recognized to enhance auto-local bone with small amount.

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“…Radiographic progression of the fusion with time was also shown when DBM was used as bone graft extender to decrease the need of autologous bone graft [ 14 ]. Intra-individual comparison of DBM augmented autograft at one side and autograft without adjunct at the contralateral side in patients who underwent postero-lateral fusion showed equal results in radiographic assessment [ 15 ]. An ex vivo histological analysis of different types of DBM products used for sinus lift procedures in oral surgery showed superiority of DBX® in terms of new bone formation and low residual demineralised matrix compared to other products [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Histological remodelling of demineralised bone matrix allograft in posterolateral fusion of the spine – an ex vivo study

et al. 2013

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BackgroundDemineralised bone matrix (DBM) has shown to be effective in enhancing posterior fusion of the spine. Several animal studies and clinical investigations in humans showed its successful remodelling. The use of allogenic matrix may decrease the need of autologous bone graft and therefore helps prevent corresponding donor site morbidity. Since DBM products are very expensive, the question arises, whether it is completely remodelled into new bone, and therefore truly is comparable to autologous cancellous bone graft. To our knowledge there is no report of a consecutive series of patients where ex vivo histological analysis after postero-lateral fusion of the spine was performed.MethodsOsseous biopsies of nine consecutive patients who underwent postero-lateral fusion of the spine for trauma were obtained at the time of elective removal of the hardware. Histological samples were then analyzed on ground and thin sections stained with toluidine blue and von Kossa stainings.ResultsTime span between index operation and removal of the metal ranged between 6 and 18 month. Histological analysis showed good incorporation and overall remodelling of DBM into new bone in all patients. No foreign body reaction was visible and new bone formation progressed time dependently with DBM in situ. Four out of nine patients showed more than 50% new bone formation after one year.ConclusionDBM shows good overall remodelling properties in histological analysis and therefore seems to be an effective adjunct in postero-lateral fusion of the spine. Furthermore, DBM substitution increases over time.

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Augmenting Local Bone With Grafton Demineralized Bone Matrix for Posterolateral Lumbar Spine Fusion: Avoiding Second Site Autologous Bone Harvest

Cited by 111 publications

References 19 publications

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

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

Demineralized Bone Matrix, as a Graft Enhancer of Auto-Local Bone in Posterior Lumbar Interbody Fusion

Histological remodelling of demineralised bone matrix allograft in posterolateral fusion of the spine – an ex vivo study

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