Bone grafting alternatives in spinal surgery

Vaccaro, Alexander R.; Chiba, Kazuhiro; Heller, John G.; Patel, Tushar; Thalgott, John S.; Truumees, Eeric; Fischgrund, Jeffrey S.; Craig, Matthew R.; Berta, Scott C.; Wang, Jeffrey C.

doi:10.1016/s1529-9430(02)00180-8

Cited by 218 publications

(133 citation statements)

References 70 publications

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Section: Discussionmentioning

confidence: 99%

“…Examples are the use of allografts, osteoinductive growth factors such as BMPs, and synthetic osteoconductive carriers [40]. Others have examined and applied the use of adjunctive internal fixation (pedicle screws, cages), electrical or magnetic stimulation, and ultrasound therapy [40]. The use of spinal instrumentation [42] has become an important and popular adjunct to bone grafting in lumbar fusion surgeries, further increasing the fusion rates (to 80-90%).…”

Section: Discussionmentioning

confidence: 99%

“…In these cases, the local environment for the graft is not conducive. The blood supply may not be adequate, thus limiting available oxygen, nutrients, neovascularization, and cellular migration to the fusion mass [40]. On the other hand, it is also in these unfavorable conditions that bone graft adjuncts, e.g.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Do autologous growth factors enhance transforaminal lumbar interbody fusion?

Hee

Majd²,

Holt

et al. 2003

European Spine Journal

149

101

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Do autologous growth factors enhance transforaminal lumbar interbody fusion?

Hee

Majd²,

Holt

et al. 2003

European Spine Journal

149

101

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“…More recently, bone graft substitute technology has expanded the current clinical methods in spine surgery, often allowing prospects for minimally invasive procedures and obviating the morbidity of iliac crest autograft [6]. Rabbit studies utilizing biologics have routinely compared those fusion rates to that of autogenous ICBG, the historical gold standard.…”

Section: Introductionmentioning

confidence: 99%

Factors influencing arthrodesis rates in a rabbit posterolateral spine model with iliac crest autograft

et al. 2013

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Purpose The rabbit posterolateral intertransverse spine arthrodesis model has been widely used to evaluate spinal biologics. However, to date, the validity and reproducibility of performance of iliac crest bone graft, the most common and critical control group, has not been firmly established. We evaluated original research publications that utilized this model, identified which experimental conditions affected fusion rates, and developed an algorithm to predict fusion rates for future study designs. Methods A MEDLINE search was performed for publications through December, 2011 that utilized this model to evaluate fusion rates elicited by iliac crest autograft. All study parameters were recorded, and logistic regression analyses were performed to determine the effects of these variables on fusion rates as determined by either manual palpation or radiographs. Results Seventy studies with 959 rabbits in 102 groups met the inclusion criteria. Excluding studies that measured fusion at 4 or fewer weeks or intentionally tried to decrease the fusion rate, the overall fusion rate for autograft was 58.3 ± 16.3 % (mean ± SD) as determined by manual palpation and 66.4 ± 17.8 % by plain radiographs. Regression analysis demonstrated a difference between these outcome measures with a trend towards significance (p = 0.09). Longer time points and larger volumes of autograft resulted in significantly greater reported fusion rates (p \ 0.0001 and p \ 0.05, respectively). Neither strain, age, weight, nor vertebral level significantly affected fusion rates. Conclusions Although experimental conditions varied across studies, time point evaluation and autograft volume significantly affected fusion rates. Despite some variability demonstrated across certain studies, we demonstrated that when the time point and volume of autograft were controlled for, the iliac crest control group of the rabbit posterolateral spinal arthrodesis model is both reliable and predictably affected by different experimental conditions.

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“…Decortication of the recipient graft bed exposes the elements of bone marrow and accelerates bone integration [6]. The biological factors involved in this phenomenon are not fully known [14]. Mesenchymal cells are believed to be recruited to differentiate into chondroblasts and osteoblasts when stimulated by local factors such as bone morphogenic protein, platelet-derived growth factor, interleukim, fibroblast growth factor, insulin-like growth factor, granulocytecolony-stimulating factors and granulocyte-macrophage colony stimulating factors [11].…”

Section: Discussionmentioning

confidence: 99%

Influence of decortication of the recipient graft bed on graft integration and tissue neoformation in the graft-recipient bed interface

Canto¹,

Garcia

Issa³

et al. 2008

Eur Spine J

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The objective of the present study was to assess the influence of decortication of the posterior elements of the vertebra (recipient bed) and the nature of the bone graft (cortical or cancellous bone) on graft integration and bone, cartilage and fiber neoformation in the interface between the vertebral recipient bed and the bone graft. Seventy-two male Wistar rats were divided into four experimental groups according to the presence or absence of decortication of the posterior vertebral elements and the use of a cortical or cancellous bone graft. Group I-the posterior elements were decorticated and cancellous bone used. Group II-the posterior elements were decorticated and cortical graft was used. Group III-the posterior elements were not decorticated and cancellous graft was used. Group IV-the posterior elements were not decorticated and cortical graft was used. The animals were killed 3, 6 and 9 weeks after surgery and the interface between the posterior elements and the bone graft was subjected to histomorphometric evaluation. Mean percent neoformed bone was 40.8% in group I (decortication and cancellous graft), 39.13% in group II (decortication and cortical graft), 6.13% in group III (non-decorticated and cancellous graft), and 9.27% in group IV (non-decorticated and cortical graft) for animals killed at 3 weeks (P = 0.0005). For animals killed at 6 weeks, the mean percent was 38.53% for group I, 40.40% for group II, 10.27% for group III, and 7.6% for group IV (P = 0.0005), and for animals killed at 9 weeks, the mean was 25.93% for group I, 30.6% for group II, 16.4% for group III, and 18.73% for group IV (P = 0.0026). The mean percent neoformed cartilage tissue was 8.36% for group I, 7.46% for group II, 11.1% for group III, and 9.13% for group IV for the animals killed at 3 weeks (P = 0.6544); 6.6% for group I, 8.07% for group, 7.47% for group III and 6.13% for group IV (P = 0.4889) for animals killed at 6 weeks, and 3.13% for group I, 4.06% for group II, 10.53% for group III and 12.07% for group IV (P = 0.0006) for animals killed at 9 weeks. Mean percent neoformed fibrous tissue was 11% for group I, 6.13% for group II, 26.27% for group III and 21.87% for group IV for animals killed at 3 weeks (P = 0.0008); 7.67% for group I, 7.1% for group II, 9.8% for group III and 10.4% for group IV (P = 0.7880) for animals killed at 6 weeks, and 3.73% for group I, 4.4% for group II, 6.67% for group III and 6.8% for group IV (P = 0.0214) for animals killed at 9 weeks. The statistically significant differences in percent tissue formation were related to decortication of the posterior elements. The use of a cortical or cancellous graft did not influence tissue neoformation. Ossification in the interface of the recipient graft bed was of the intramembranous type in the decorticated animals and endochondral type in the nondecorticated animals.

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Bone grafting alternatives in spinal surgery

Cited by 218 publications

References 70 publications

Do autologous growth factors enhance transforaminal lumbar interbody fusion?

Do autologous growth factors enhance transforaminal lumbar interbody fusion?

Factors influencing arthrodesis rates in a rabbit posterolateral spine model with iliac crest autograft

Influence of decortication of the recipient graft bed on graft integration and tissue neoformation in the graft-recipient bed interface

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