Bone graft substitutes are widely used in the field of orthopedics and are extensively used to promote vertebral fusion. Fusion is the most common technique in spine surgery and is used to treat morbidities and reliev...Bone graft substitutes are widely used in the field of orthopedics and are extensively used to promote vertebral fusion. Fusion is the most common technique in spine surgery and is used to treat morbidities and relieve discomfort. Allograft and autograft bone substitutes are currently the most commonly used bone grafts to promote fusion. These approaches pose limitations and present complications to the patient. Numerous alternative bone graft substitutes are on the market or have been developed and proposed for application. These options have attempted to promote spine fusion by enhancing osteogenic properties. In this review, we reviewed biology of spine fusion and the current advances in biomedical materials and biological strategies for application in surgical spine fusion. Our findings illustrate that, while many bone graft substitutes perform well as bone graft extenders, only osteoinductive proteins(recombinant bone morphogenetic proteins-2 and osteogenic protein-1) provide evidence for use as both bone enhancers and bone substitutes for specific types of spinal fusion. Tissue engineered hydrogels, synthetic polymer composites and viral based gene therapy also holds the potential to be used for spine fusion in future, though warrants further investigation to be used in clinical practice.展开更多
Objective To investigate the clinical effect of bone graft impaction on posterior intervertebral fusion for lumbar spondylolisthesis.Methods From January 2001 to July 2008,36 patients with lumbar spondylolisthesis wer...Objective To investigate the clinical effect of bone graft impaction on posterior intervertebral fusion for lumbar spondylolisthesis.Methods From January 2001 to July 2008,36 patients with lumbar spondylolisthesis were treated by展开更多
Objective To evaluate the clinical application of atlantoaxial joint fusion using anterior transarticular screw fixation and bone grafting for atlantoaxial joint instability. Methods Twenty-three cases of atlantoaxial...Objective To evaluate the clinical application of atlantoaxial joint fusion using anterior transarticular screw fixation and bone grafting for atlantoaxial joint instability. Methods Twenty-three cases of atlantoaxial joint instability were展开更多
Multilevel lumbar fusion usually requires a large quantity of iliac crest bone graft but the supply is usually insufficient, so an alternative bone graft substitute for autograft is needed. This prospective study inve...Multilevel lumbar fusion usually requires a large quantity of iliac crest bone graft but the supply is usually insufficient, so an alternative bone graft substitute for autograft is needed. This prospective study investigated the efficacy of calcium sulfate by comparing the fusion rates between the experimental material (calcium sulfate pellets with bone chips from laminectomy) and autologous iliac bone graft in long segment (three-or four-level) lumbar and lumbosacral posterolateral fusion. Forty-five patients with degenerative scoliosis or spondylolisthesis received multilevel spine fusion and decompression. The experimental material of calcium sulfate pellets with decompression bone chips was placed on the experimental side and the iliac crest bone graft was placed on the control side. The fusion status was assessed radiographically at three-month intervals, and solid fusion was defined as a clear continuous intertransverse bony bridge at all levels. The average follow-up period was 34.4 months. Twenty-nine (64.4%) patients showed solid fusion on the experimental side and 39 (86.7%) patients on the control side. The overall fusion rate was 86.7%. A statistically significant relation was found between the two sides with the Kappa coefficient of agreement of 0.436. Compared to the control side, the fusion rate of experimental side is significantly reduced (p = 0.014). The fusion ability of autograft is higher than the experimental material in multilevel lumbar posterolateral fusion. However, the overall fusion rate of calcium sulfate pellets is improved, compared with previously reported rates, which suggested that such material may be considered as an acceptable bone graft extender.展开更多
Spinal fusion remains the gold-standard treatment for several pathological spine conditions. Although, autologous Iliac Crest Bone Grafting is considered the goldstandard graft choice to promote spinal fusion; however...Spinal fusion remains the gold-standard treatment for several pathological spine conditions. Although, autologous Iliac Crest Bone Grafting is considered the goldstandard graft choice to promote spinal fusion; however, it is associated with significant donor site morbidity and a limited graft quantity. Therefore, several bone graft alternatives have been developed, to augment arthrodesis. The purpose of this review is to present the results of clinical studies concerning the use of demineralized bone matrix(DBM), alone or as a composite graft, in the spinal fusion. A critical review of the English-language literature was conducted on Pubmed, using key word "demineralized bone matrix", "DBM", "spinal fusion", and "scoliosis". Results had been restricted to clinical studies. The majority of clinical trials demonstrate satisfactory fusion rates when DBM is employed as a graft extender or a graft enhancer.Limited number of prospective randomized controlled trials(4 studies), have been performed comparing DBM to autologous iliac crest bone graft in spine fusion. The majority of the clinical trials demonstrate comparable efficacy of DBM when it used as a graft extender in combination with autograft, but there is no clinical evidence to support its use as a standalone graft material. Additionally, high level of evidence studies are required, in order to optimize and clarify the indications of its use and the appropriate patient population that will benefit from DBM in spine arthrodesis.展开更多
Introduction: Lumbar fusion as low back pain treatment continues to be a challenge because of the multiple techniques and materials available, most popular techniques include Transforaminal lumbar interbody fusion (TL...Introduction: Lumbar fusion as low back pain treatment continues to be a challenge because of the multiple techniques and materials available, most popular techniques include Transforaminal lumbar interbody fusion (TLIF), Lateral lumbar interbody fusion (LLIF) and Anterior lumbar interbody fusion (ALIF). Successful lumbar fusion is associated with better clinical outcomes, and it is enhanced and targeted through the use of bone graft materials as an osteogenic cell binding peptide P-15, bound to an anorganic bone mineral (ABM). This peptide improves bone formation when used in fixation devices in a targeted and limited way to the implant surface by activating osteoblast precursor cells;by the osteogenic, osteoinductive and osteoconductive stimuli. The main objective of this study is to standardize the lumbar fusion process in the 3 techniques and achieve a more efficient and predictable lumbar fusion, evaluating results with radiological and clinical scales. Material and Methods: Patients underwent lumbar fusion with the use of P-15 Osteogenic Cell Binding Peptide, bound to an anorganic bone mineral (P-15/ABM) bone graft (5 cc) in three different techniques (TLIF, LLIF, ALIF), achieving a total of 100 lumbar levels. Radiological outcomes included fusion rates per Hounsfield Units at computed tomography (CT) scan and Lenke scale. Clinical outcomes were evaluated via the Oswestry Disability Index (ODI), Short Form Performance (SPF-36) and Visual Analog Scale (VAS and VASs) for pain and satisfaction. Results: 67 patients completed the 12 months follow-up, showing no differences in fusion rates between techniques. (Computed Tomography Hounsfield Units) CTHU reaches more than 200 UH at 3 months follow-up and continues fusion process till 12-month follow-up. Clinical scales showed no disability at ODI, improvement at VAS and VASs scales, absence of health restrictions at SPF-36 score since 6 months follow up. Conclusion: Bone graft volume of 5 cc is adequate for achieving successful lumbar fusion, regardless of the surgical technique employed.展开更多
Bone morphogenetic proteins are osteoinductive factors which have gained popularity in orthopaedicsurgery and especially in spine surgery. The use of recombinant human bone morphogenetic protein-2 has been officially ...Bone morphogenetic proteins are osteoinductive factors which have gained popularity in orthopaedicsurgery and especially in spine surgery. The use of recombinant human bone morphogenetic protein-2 has been officially approved by the United States Food and Drug Administration only for single level anterior lumbar interbody fusion, nevertheless it is widely used by many surgeons with off-label indications. Despite advantages in bone formation, its use still remains a controversial issue and several complications have been described by authors who oppose their wide use.展开更多
文摘Bone graft substitutes are widely used in the field of orthopedics and are extensively used to promote vertebral fusion. Fusion is the most common technique in spine surgery and is used to treat morbidities and relieve discomfort. Allograft and autograft bone substitutes are currently the most commonly used bone grafts to promote fusion. These approaches pose limitations and present complications to the patient. Numerous alternative bone graft substitutes are on the market or have been developed and proposed for application. These options have attempted to promote spine fusion by enhancing osteogenic properties. In this review, we reviewed biology of spine fusion and the current advances in biomedical materials and biological strategies for application in surgical spine fusion. Our findings illustrate that, while many bone graft substitutes perform well as bone graft extenders, only osteoinductive proteins(recombinant bone morphogenetic proteins-2 and osteogenic protein-1) provide evidence for use as both bone enhancers and bone substitutes for specific types of spinal fusion. Tissue engineered hydrogels, synthetic polymer composites and viral based gene therapy also holds the potential to be used for spine fusion in future, though warrants further investigation to be used in clinical practice.
文摘Objective To investigate the clinical effect of bone graft impaction on posterior intervertebral fusion for lumbar spondylolisthesis.Methods From January 2001 to July 2008,36 patients with lumbar spondylolisthesis were treated by
文摘Objective To evaluate the clinical application of atlantoaxial joint fusion using anterior transarticular screw fixation and bone grafting for atlantoaxial joint instability. Methods Twenty-three cases of atlantoaxial joint instability were
文摘Multilevel lumbar fusion usually requires a large quantity of iliac crest bone graft but the supply is usually insufficient, so an alternative bone graft substitute for autograft is needed. This prospective study investigated the efficacy of calcium sulfate by comparing the fusion rates between the experimental material (calcium sulfate pellets with bone chips from laminectomy) and autologous iliac bone graft in long segment (three-or four-level) lumbar and lumbosacral posterolateral fusion. Forty-five patients with degenerative scoliosis or spondylolisthesis received multilevel spine fusion and decompression. The experimental material of calcium sulfate pellets with decompression bone chips was placed on the experimental side and the iliac crest bone graft was placed on the control side. The fusion status was assessed radiographically at three-month intervals, and solid fusion was defined as a clear continuous intertransverse bony bridge at all levels. The average follow-up period was 34.4 months. Twenty-nine (64.4%) patients showed solid fusion on the experimental side and 39 (86.7%) patients on the control side. The overall fusion rate was 86.7%. A statistically significant relation was found between the two sides with the Kappa coefficient of agreement of 0.436. Compared to the control side, the fusion rate of experimental side is significantly reduced (p = 0.014). The fusion ability of autograft is higher than the experimental material in multilevel lumbar posterolateral fusion. However, the overall fusion rate of calcium sulfate pellets is improved, compared with previously reported rates, which suggested that such material may be considered as an acceptable bone graft extender.
文摘Spinal fusion remains the gold-standard treatment for several pathological spine conditions. Although, autologous Iliac Crest Bone Grafting is considered the goldstandard graft choice to promote spinal fusion; however, it is associated with significant donor site morbidity and a limited graft quantity. Therefore, several bone graft alternatives have been developed, to augment arthrodesis. The purpose of this review is to present the results of clinical studies concerning the use of demineralized bone matrix(DBM), alone or as a composite graft, in the spinal fusion. A critical review of the English-language literature was conducted on Pubmed, using key word "demineralized bone matrix", "DBM", "spinal fusion", and "scoliosis". Results had been restricted to clinical studies. The majority of clinical trials demonstrate satisfactory fusion rates when DBM is employed as a graft extender or a graft enhancer.Limited number of prospective randomized controlled trials(4 studies), have been performed comparing DBM to autologous iliac crest bone graft in spine fusion. The majority of the clinical trials demonstrate comparable efficacy of DBM when it used as a graft extender in combination with autograft, but there is no clinical evidence to support its use as a standalone graft material. Additionally, high level of evidence studies are required, in order to optimize and clarify the indications of its use and the appropriate patient population that will benefit from DBM in spine arthrodesis.
文摘Introduction: Lumbar fusion as low back pain treatment continues to be a challenge because of the multiple techniques and materials available, most popular techniques include Transforaminal lumbar interbody fusion (TLIF), Lateral lumbar interbody fusion (LLIF) and Anterior lumbar interbody fusion (ALIF). Successful lumbar fusion is associated with better clinical outcomes, and it is enhanced and targeted through the use of bone graft materials as an osteogenic cell binding peptide P-15, bound to an anorganic bone mineral (ABM). This peptide improves bone formation when used in fixation devices in a targeted and limited way to the implant surface by activating osteoblast precursor cells;by the osteogenic, osteoinductive and osteoconductive stimuli. The main objective of this study is to standardize the lumbar fusion process in the 3 techniques and achieve a more efficient and predictable lumbar fusion, evaluating results with radiological and clinical scales. Material and Methods: Patients underwent lumbar fusion with the use of P-15 Osteogenic Cell Binding Peptide, bound to an anorganic bone mineral (P-15/ABM) bone graft (5 cc) in three different techniques (TLIF, LLIF, ALIF), achieving a total of 100 lumbar levels. Radiological outcomes included fusion rates per Hounsfield Units at computed tomography (CT) scan and Lenke scale. Clinical outcomes were evaluated via the Oswestry Disability Index (ODI), Short Form Performance (SPF-36) and Visual Analog Scale (VAS and VASs) for pain and satisfaction. Results: 67 patients completed the 12 months follow-up, showing no differences in fusion rates between techniques. (Computed Tomography Hounsfield Units) CTHU reaches more than 200 UH at 3 months follow-up and continues fusion process till 12-month follow-up. Clinical scales showed no disability at ODI, improvement at VAS and VASs scales, absence of health restrictions at SPF-36 score since 6 months follow up. Conclusion: Bone graft volume of 5 cc is adequate for achieving successful lumbar fusion, regardless of the surgical technique employed.
文摘目的:观察病灶清除植骨融合联合外固定架治疗腕关节结核的临床疗效。方法:2015年10月至2019年5月,采用病灶清除植骨融合联合外固定术治疗25例晚期腕关节结核患者,男14例,女11例;年龄40~74 (60.72±8.45)岁;病程5~24 (11.52±7.61)个月;左腕结核11例,右腕结核14例,合并窦道形成者5例。术后继续规律抗结核,观察患者治疗前后视觉模拟疼痛评分(vasual analogue scale,VAS)、炎症指标、Gartland-Werley腕关节功能评分、上肢功能评分(disabilities of the arm,shoulder and hand,DASH)。结果:25例患者获得随访,时间12~36(19.7±6.3)个月,末次随访患者切口愈合可,均无结核、感染复发。术前1周与术后3个月VAS分别为(5.16±1.14)、(1.68±0.80)分,红细胞沉降率(enythrocyte sedimentation rate,ESR)分别为(44.20±20.56)、(14.44±1.14) mm·h^(-1),C反应蛋白(C-reactive protein,CRP)为(12.37±7.95)、(4.30±3.37) mg·L^(-1),各时间点比较差异均有统计学意义(P<0.01)。术前1周与术后1年Gartland-Werley腕关节功能评分分别为(21.32±3.44)、(14.96±1.37)分,两者比较差异有统计学意义(P<0.01);DASH由术前1周的(70.52±7.95)分,提高至术后1年的(28.84±2.30)分(P<0.01)。末次随访所有患者结核病无复发。结论:采用病灶清除植骨融合联合外固定术治疗腕关节结核近期临床疗效满意。
文摘Bone morphogenetic proteins are osteoinductive factors which have gained popularity in orthopaedicsurgery and especially in spine surgery. The use of recombinant human bone morphogenetic protein-2 has been officially approved by the United States Food and Drug Administration only for single level anterior lumbar interbody fusion, nevertheless it is widely used by many surgeons with off-label indications. Despite advantages in bone formation, its use still remains a controversial issue and several complications have been described by authors who oppose their wide use.
