Two-Year Fusion Rate Equivalency Between Grafton® DBM Gel and Autograft in Posterolateral Spine Fusion

Cammisa, Frank P.; Lowery, Gary L.; Garfin, Steven R.; Geisler, Fred H.; Klara, Peter M.; McGuire, Robert A.; Sassard, Walter R.; Stubbs, Harrison A.; Block, Jon E.

doi:10.1097/01.brs.0000116588.17129.b9

Cited by 184 publications

(50 citation statements)

References 27 publications

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“…However, the incidence of complications associated with harvesting bone from the posterior iliac crest is significant. Various graft substitutes or autograft extenders have become available or are currently under development including allografts [1,2], ceramics [3,4], demineralized bone matrix (DBM) [5,6], and cultured stem cells [7]. Some of these substitutes function as osteoconductors or as osteoinductors in the process of osteogenesis.…”

Section: Introductionmentioning

confidence: 99%

Identification of mesenchymal stem cells and osteogenic factors in bone marrow aspirate and peripheral blood for spinal fusion by flow cytometry and proteomic analysis

et al. 2014

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BackgroundAn in vivo animal study and a prospective clinical study have indicated that bone marrow aspirate (BMA) augments spinal arthrodesis. However, there is no quantified data to explain why fusion rate can be augmented by BMA in lumbar posterolateral fusion.MethodsTo analyze the proportion of mesenchymal stem cells (MSCs) and osteogenic factors in human BMA and peripheral blood (PB) of the same patient. Autologous BMA and PB from the patients were analyzed by flow cytometry (FACS) using cell markers for MSCs. The osteogenic potential of MSCs was determined by alkaline phosphatase (ALP) activity and calcium level quantification. Proteomics were used for the qualitative and quantitative mapping of the whole proteome from BMA and PB plasma. The mass-to-charge ratio was calculated by time-of-flight mass spectrometry (TOF-MS). The overexpression of protein was confirmed using Western blot analysis.ResultsThe proportion of MSCs (CD34−/CD29+/CD105+) was higher in the BMA than that in the PB. Colony-forming cell (CFC) assays suggested that fewer colonies were formed in PB cultures than in BMA culture. There was no significant difference in the osteogenic potential of the MSCs between the PB and BMA. Proteomic mass spectrometry assays suggested that the levels of catalase (osteoclast inhibitor) and glutathione peroxidase 3 (osteogenic biomarker) were higher in the BMA than those in the PB, and this was confirmed by Western blot analysis.ConclusionsThe proportions of MSCs and osteogenic factors were higher in the BMA than in the PB. This may explain why fusion rate can be augmented by BMA in lumbar posterolateral fusion.

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Section: Introductionmentioning

confidence: 99%

Identification of mesenchymal stem cells and osteogenic factors in bone marrow aspirate and peripheral blood for spinal fusion by flow cytometry and proteomic analysis

et al. 2014

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“…Demineralized bone matrix is a viable alternative [9,24,28]. Removing the mineralized phase of bone through a rigorous sterilization process certainly decreases the risk of viral and bacterial infection [12,18,26].…”

Section: Discussionmentioning

confidence: 99%

The Clinical Use of Allografts, Demineralized Bone Matrices, Synthetic Bone Graft Substitutes and Osteoinductive Growth Factors: A Survey Study

Bostrom

Seigerman

2005

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

128

104

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The emergence of new bone grafting options and alternatives has led to significant uncertainty when determining the most appropriate product for surgical procedures requiring bone graft in orthopedics. Allografts, demineralized bone matrices, synthetic bone graft substitutes, and osteoinductive growth factors are all viable options, yet there is a lack of data reporting clinical usage of these products. This correspondence reports on the use of bone grafting products at the Hospital for Special Surgery for a 27-month period and makes recommendations based on surgical usage, safety, and cost. Approximately half (48.6%) of all bone graft substitutes were implanted during spinal surgery. Arthroplasty, trauma, and foot/hand cases all used considerable amounts of bone grafting products as well (20.1%, 19.0%, 12.1%, respectively). Considerable differences were noticed in usage of bone grafting products among each orthopedic discipline. Of all bone graft substitutes used in arthroplasty, 14.4% were demineralized bone matrices, whereas 56.8% were allografts. Demineralized bone matrix grafts were used in 82% of trauma surgery and 89% of foot/hand cases. An increase in synthetic bone graft alternatives was noticed near the end of our investigation period.

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“…Cammisa et al [21] conducted a multicenter prospective study that compared the effectiveness of a Grafton DBM gel composite with an iliac crest autograft in posterolateral spinal fusion; they reported that Grafton DBM could only extend an autograft that was smaller than is normally required to achieve a solid spinal fusion (Level II). Vaccaro et al [96], in a prospective study, also reported that the DBM composite consisting of DBM putty and aspirated bone marrow offer a similar performance as the autograft in posterolateral spinal fusion (Level II).…”

Section: Demineralized Bone Matricesmentioning

confidence: 99%

An update on bone substitutes for spinal fusion

et al. 2009

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With the current advances in spinal surgery, an understanding of the precise biological mechanism of each bone substitute is necessary for inducing successful spinal fusion. In this review, the categories of bone substitutes include allografts, ceramics, demineralized bone matrix, osteoinductive factors, autogenous platelet concentrate, mesenchymal stem cells, and gene therapy. Further, clinical studies have been evaluated by their levels of evidence in order to elucidate the precise effect of the bone substitute employed and to establish clinical guidance. This article will review both clinical studies based on evidence and basic research in current advances in order to avoid as far as possible any chances of failure in the future and to understand cellular biology in novel technologies.

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Two-Year Fusion Rate Equivalency Between Grafton® DBM Gel and Autograft in Posterolateral Spine Fusion

Abstract: Grafton DBM can extend a smaller quantity of autograft than is normally required to achieve a solid spinal arthrodesis. Consequently, a reduced amount of harvested autograft may be required, potentially diminishing the risk and severity of donor site complications.

Cited by 184 publications

References 27 publications

Identification of mesenchymal stem cells and osteogenic factors in bone marrow aspirate and peripheral blood for spinal fusion by flow cytometry and proteomic analysis

Identification of mesenchymal stem cells and osteogenic factors in bone marrow aspirate and peripheral blood for spinal fusion by flow cytometry and proteomic analysis

The Clinical Use of Allografts, Demineralized Bone Matrices, Synthetic Bone Graft Substitutes and Osteoinductive Growth Factors: A Survey Study

An update on bone substitutes for spinal fusion

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