Improving the Clinical Evidence of Bone Graft Substitute Technology in Lumbar Spine Surgery

Hsu, Wellington K.; Nickoli, Michael S.; Wang, J. C.; Lieberman, Jay R.; An, Howard S.; Yoon, S. Tim; Youssef, Jim A.; Brodke, Darrel S.; McCullough, C. M.

doi:10.1055/s-0032-1315454

Cited by 65 publications

(51 citation statements)

References 73 publications

(86 reference statements)

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“…The use of local bone graft from laminectomy and facetectomy sites during decompression has gained popularity in recent years [14]. Local bone graft alone in PLF can achieve good radiological and clinical outcomes [151617].…”

Section: Discussionmentioning

confidence: 99%

Bone Union Rate Following Instrumented Posterolateral Lumbar Fusion: Comparison between Demineralized Bone Matrix versus Hydroxyapatite

Nam

Jemin

2016

Asian Spine J

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Study DesignRetrospective study.PurposeTo compare the union rate of posterolateral lumbar fusion (PLF) using demineralized bone matrix (DBM) versus hydroxyapatite (HA) as bone graft extender.Overview of LiteratureTo our knowledge, there has been no clinical trial to compare the outcomes of DBM versus HA as a graft material for PLF.MethodsWe analyzed prospectively collected data from consecutive 79 patients who underwent instrumented PLF. Patients who received DBM were assigned to group B (n=38), and patients who received HA were assigned into group C (n=41). The primary study outcome was fusion rate assessed with radiographs. The secondary outcomes included pain intensity using a visual analogue scale, functional outcome using Oswestry disability index score, laboratory tests of inflammatory profiles and infection rate.ResultsOne year postoperatively, bone fusion was achieved in 73% in group B and 58% in group C without significant difference between the groups (p=0.15). There were no differences between the groups with respect to secondary outcomes.ConclusionsDBM would provide noninferior outcomes compared to the HA as a fusion material for PLF, and could be a notable alternative.

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Section: Discussionmentioning

confidence: 99%

Bone Union Rate Following Instrumented Posterolateral Lumbar Fusion: Comparison between Demineralized Bone Matrix versus Hydroxyapatite

Nam

Jemin

2016

Asian Spine J

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“…34 While the reporting methods of the publications included from this review varied, these reported fusion rates suggest a benefit from the proper use of bone graft extenders and substitutes.…”

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confidence: 99%

Lumbar pseudarthrosis: a review of current diagnosis and treatment

Chun

Baker

Hsu

2015

FOC

Self Cite

153

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OBJECT Failed solid bony fusion, or pseudarthrosis, is a well-known complication of lumbar arthrodesis. Recent advances in radiographic technology, biologics, instrumentation, surgical technique, and understanding of the local biology have all aided in the prevention and treatment of pseudarthrosis. Here, the current literature on the diagnosis and management of lumbar pseudarthroses is reviewed. METHODS A systematic literature review was conducted using the MEDLINE and Embase databases in order to search for the current radiographie diagnosis and surgical treatment methods published in the literature (1985 to present). Inclusion criteria included: 1) published in English; 2) level of evidence I–III; 3) diagnosis of degenerative lumbar spine conditions and/or history of lumbar spine fusion surgery; and 4) comparative studies of 2 different surgical techniques or comparative studies of imaging modality versus surgical exploration. RESULTS Seven studies met the inclusion criteria for current radiographie imaging used to diagnose lumbar pseudarthrosis. Plain radiographs and thin-cut CT scans were the most common method for radiographie diagnosis. PET has been shown to be a valid imaging modality for monitoring in vivo active bone formation. Eight studies compared the surgical techniques for managing and preventing failed lumbar fusion. The success rates for the treatment of pseudarthrosis are enhanced with the use of rigid instrumentation. CONCLUSIONS Spinal fusion rates have improved secondary to advances in biologies, instrumentation, surgical techniques, and understanding of local biology. Treatment of lumbar pseudarthrosis includes a variety of surgical options such as replacing loose instrumentation, use of more potent biologies, and interbody fusion techniques. Prevention and recognition are important tenets in the algorithm for the management of spinal pseudarthrosis.

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“…The overall fusion rate achieved was reported at 75 % for ICBG and 65 % with local bone grafts [12]; however, when only multilevel fusions were performed, the fusion rates for ICBG and local bone were 66 % and 20 %, respectively. Historical data report fusion rates with the use of iliac crest in PLF from 50 to 90 % [10]. In addition, for scoliotic patients the mean correction of the deformity was in the range of published series using iliac crest graft, 57 % ± 14 % for iliac crest graft group [13].…”

Section: Discussionmentioning

confidence: 99%

“…A range of 65 to 95 % of successful fusion rates based on plain radiographic imaging was reported [10]. The local available bone chips are of limited volume and insufficient for multilevel fusions.…”

Section: Discussionmentioning

confidence: 99%

Natural hydroxyapatite as a bone graft extender for posterolateral spine arthrodesis

Garin

Boutrand

2016

International Orthopaedics (SICOT)

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Improving the Clinical Evidence of Bone Graft Substitute Technology in Lumbar Spine Surgery

Cited by 65 publications

References 73 publications

Bone Union Rate Following Instrumented Posterolateral Lumbar Fusion: Comparison between Demineralized Bone Matrix versus Hydroxyapatite

Bone Union Rate Following Instrumented Posterolateral Lumbar Fusion: Comparison between Demineralized Bone Matrix versus Hydroxyapatite

Lumbar pseudarthrosis: a review of current diagnosis and treatment

Natural hydroxyapatite as a bone graft extender for posterolateral spine arthrodesis

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