Current Updates on Bone Grafting Biomaterials and Recombinant Human Growth Factors Implanted Biotherapy for Spinal Fusion: A Review of Human Clinical Studies

Abstract

Background:Owing to their great promise in the spinal surgeries, bone graft substitutes have been widely investigated for their safety and clinical potential. By the current advances in the spinal surgery, an understanding of the precise biological mechanism of each bone graft substitute is mandatory for upholding the induction of solid spinal fusion.Objective:The aim of the present review is to critically discuss various surgical implications and level of evidence of most commonly employed bone graft substitutes for spinal fusion.Method:Data was collected via electronic search using “PubMed”, “SciFinder”, “ScienceDirect”, “Google Scholar”, “Web of Science” and a library search for articles published in peer-reviewed journals, conferences, and e-books.Results:Despite having exceptional inherent osteogenic, osteoinductive, and osteoconductive features, clinical acceptability of autografts (patient’s own bone) is limited due to several perioperative and postoperative complications i.e., donor-site morbidities and limited graft supply. Alternatively, allografts (bone harvested from cadaver) have shown great promise in achieving acceptable bone fusion rate while alleviating the donor-site morbidities associated with implantation of autografts. As an adjuvant to allograft, demineralized bone matrix (DBM) has shown remarkable efficacy of bone fusion, when employed as graft extender or graft enhancer. Recent advances in recombinant technologies have made it possible to implant growth and differentiation factors (bone morphogenetic proteins) for spinal fusion.Selection of a particular bone grafting biotherapy can be rationalized based on the level of spine fusion, clinical experience and preference of orthopaedic surgeon, and prevalence of donor-site morbidities.

Analysis of risk factors for perioperative hidden blood loss in unilateral biportal endoscopic spine surgery: a retrospective multicenter study

“…Our study demonstrated that operative time and number of fusion levels were independent risk factors for perioperative HBL in UBE surgery. Several prior studies have also suggested that number of fusion levels is a predictor of blood transfusion in spinal surgery [ 33 , 34 ].…”

Establishment and assessment of a nomogram for predicting blood transfusion risk in posterior lumbar spinal fusion

“…Posterior spinal fusion is the procedure of choice for patients with trauma, spinal infection, spinal deformities, and degenerative spinal diseases [16]. The total number of operations in PSL has been rising annually, especially in China [17,18]. Significant blood loss is the most frequent surgical complication and receiving a great deal of attention in the spinal surgeon, as well as anesthesiologist [19].…”

First Human Leucocyte Antigen (HLA) Response and Safety Evaluation of Fibrous Demineralized Bone Matrix in a Critical Size Femoral Defect Model of the Sprague-Dawley Rat

“…Implanted into a living organism, rapid absorption within 6–8 weeks is expected. Lee et al, however, observed incorporation of the DBM into the reshaped bone [ 51 ]. At best, a small part was absorbed.…”