Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 16: Bone graft extenders and substitutes as an adjunct for lumbar fusion

Kaiser, Michael G.; Groff, Michael W.; Watters, William C.; Ghogawala, Zoher; Mummaneni, Praveen V.; Dailey, Andrew T.; Choudhri, Tanvir F.; Eck, Jason C.; Sharan, Alok; Wang, Jeffrey C.; Dhall, Sanjay S.; Resnick, Daniel K.

doi:10.3171/2014.4.spine14325

Cited by 59 publications

(40 citation statements)

References 68 publications

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“…62 Another major variable in the reviewed studies was the selection of bone graft and bone graft extenders. These graft extenders may have substantially different effects on spinal fusion outcomes, 12,20,25 and have previously been shown to have varying effects in bone tissue engineering with PRP. 28 For example, while HA and b-TCP are both ceramic bone graft extenders that are meant to simulate the mineralized phase of bone, with demonstrated osteoconductivity and well-documented biocompatibility, 20 they are reabsorbed at different rates with b-TCP requiring several months compared to several years for HA.…”

Section: Discussionmentioning

confidence: 97%

“…However, iliac crest autograft harvesting can be associated with significant morbidity, 32 and fusion failure with pseudoarthrosis is still found in around 10% of cases in the literature. 25 Therefore, other methods such as using bone graft extenders and biologics have been used to augment spinal fusion rates. Some of these strategies include allograft bone products, demineralized bone matrix, ceramic bone graft extenders, mesenchymal stem cells (MSCs) and biologics such as recombinant human bone morphogenetic protein-2 (rhBMP-2) and rhBMP-7, as well as platelet-rich plasma (PRP), and these have been reviewed in detail previously.…”

Section: Introductionmentioning

confidence: 99%

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A Systematic Assessment of the Use of Platelet-Rich Plasma in Spinal Fusion

et al. 2015

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Spinal fusion is one of the most commonly performed procedures for the treatment of spinal instability caused by a multitude of pathologies. However, despite significant advances in spinal instrumentation, failed fusion, or pseudoarthrosis, remains a significant challenge. Therefore, other additives such as bone graft extenders and growth factors have been explored as a method to augment fusion rates. Platelet-rich plasma (PRP) represents an additional approach, as it has shown some promise in bone regeneration. While the general use of PRP in orthopedic applications has been reviewed previously, its use in spinal fusion has not been systematically analyzed. The objective of this review is to systematically discuss the role of PRP in augmentation of bone regeneration for the purpose of spinal fusion. Background information on PRP, including a discussion of its preparation, activation, and growth factors, is included. Additionally, data from in vitro studies utilizing PRP in bone tissue engineering strategies is analyzed, and the available animal and clinical studies are systematically reviewed in order to provide guidance on future research pathways as well as the potential role of PRP in spinal fusion surgery.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

A Systematic Assessment of the Use of Platelet-Rich Plasma in Spinal Fusion

et al. 2015

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“…In the current study, high fusion rates were achieved with local autograft, comparable with studies that relied on the use of BMP or iliac crest bone graft. 1–15,21 The cost and potential complications associated with the use of BMP are well-known 19,20,27–30 and are best avoided, if possible.…”

Section: Discussionmentioning

confidence: 99%

Modified Mini-open Transforaminal Lumbar Interbody Fusion

Pakzaban¹

2016

Spine

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Study Design.Retrospective case series.Objective.To describe a modified technique for mini-open transforaminal lumbar interbody fusion (TLIF) that improves visualization for decompression, fusion, and freehand pedicle screw insertion. Accuracy of freehand pedicle screw placement with this technique was assessed.Summary of Background Data.Mini-open TLIF is a minimally invasive technique that allows limited visualization of the bone and neural anatomy via an expandable tubular retractor inserted through the Wiltse plane. No significant modification that of this technique has been described in detail.Methods.In this study, 92 consecutive patients underwent one-level modified mini-open TLIF (MOTLIF). MOTLIF modifications consisted of (i) transmuscular dissection through the multifidus muscle rather than intermuscular dissection in the Wiltse plane; (ii) microsurgical detachment of multifidus from the facet rather than muscle dilation; (iii) en bloc total facetectomy (unilateral or bilateral, as needed for decompression); (iv) facet autograft used for interbody fusion; and (v) solid pedicle screws placed bilaterally by a freehand technique under direct vision.Results.The mean age was 53 years. Mean follow-up was 35 months (minimum 2 yrs). By 6 months, mean Visual Analog Scale for back and leg pain had improved from 51 to 19 and from 58 to 17, respectively, and mean Oswestry Disability Index (ODI) improved from 53 to 16. These improvements persisted at 2 years. Solid fusion, defined by computed tomography at 1 year, was achieved in 88.1%, whereas satisfactory fusion was achieved in 95.2% of patients. Pedicle screws were accurately placed in 335 of 336 imaged pedicles (pedicle breach grades: 91.1% grade 1; 8.6% grade 2; and 0.3% grade 3). Mean fluoroscopy time was 29.3 seconds.Conclusion.MOTLIF is a safe and effective minimally invasive technique with a high fusion rate. It allows accurate pedicle screw placement by a freehand technique. By eliminating bi-planar fluoroscopy, it helps reduce radiation exposure. This is the largest published report of mini-open TLIF to date.Level of Evidence: 4

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“…While autologous iliac crest bone is recognized as the most successful grafting material due to its osteoconductive, osteogenic and osteoinductive properties [1,2], complication rates of this invasive procedure remain high [3][4][5], with protracted postoperative pain at the donor site being the most commonly reported complication [6]. In an attempt to limit such complications by either reducing or eliminating iliac crest autograft harvest, demineralized bone matrix (DBM) and synthetic osteoconductive bone graft extenders (BGEs) are often used in spinal fusion procedures as an adjunct to patient-derived autograft [7][8][9][10][11]. Similarly, local bone may be used in lieu of iliac crest grafts, although current evidence suggests that while local bone is equally effective as iliac crest bone in single-level fusion [6,12], it has been associated with significantly lower fusion rates when utilized in multi-level fusion due to volume limitations [1].…”

Section: Introductionmentioning

confidence: 99%

Hybrid Biosynthetic Autograft Extender for Use in Posterior Lumbar Interbody Fusion: Safety and Clinical Effectiveness

Chedid¹,

Tundo²,

Block³

et al. 2015

Open Orthopaedics J

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Autologous iliac crest bone graft is the preferred option for spinal fusion, but the morbidity associated with bone harvest and the need for graft augmentation in more demanding cases necessitates combining local bone with bone substitutes. The purpose of this study was to document the clinical effectiveness and safety of a novel hybrid biosynthetic scaffold material consisting of poly(D,L-lactide-co-glycolide) (PLGA, 75:25) combined by lyophilization with unmodified high molecular weight hyaluronic acid (10-12% wt:wt) as an extender for a broad range of spinal fusion procedures. We retrospectively evaluated all patients undergoing single-and multi-level posterior lumbar interbody fusion at an academic medical center over a 3-year period. A total of 108 patients underwent 109 procedures (245 individual vertebral levels). Patient-related outcomes included pain measured on a Visual Analog Scale. Radiographic outcomes were assessed at 6 weeks, 3-6 months, and 1 year postoperatively. Radiographic fusion or progression of fusion was documented in 221 of 236 index levels (93.6%) at a mean (±SD) time to fusion of 10.2+4.1 months. Single and multilevel fusions were not associated with significantly different success rates. Mean pain scores (+SD) for all patients improved from 6.8+2.5 at baseline to 3.6+2.9 at approximately 12 months. Improvements in VAS were greatest in patients undergoing one-or two-level fusion, with patients undergoing multi-level fusion demonstrating lesser but still statistically significant improvements. Overall, stable fusion was observed in 64.8% of vertebral levels; partial fusion was demonstrated in 28.8% of vertebral levels. Only 15 of 236 levels (6.4%) were non-fused at final follow-up.

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Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 16: Bone graft extenders and substitutes as an adjunct for lumbar fusion

Cited by 59 publications

References 68 publications

A Systematic Assessment of the Use of Platelet-Rich Plasma in Spinal Fusion

A Systematic Assessment of the Use of Platelet-Rich Plasma in Spinal Fusion

Modified Mini-open Transforaminal Lumbar Interbody Fusion

Hybrid Biosynthetic Autograft Extender for Use in Posterior Lumbar Interbody Fusion: Safety and Clinical Effectiveness

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