Synthetic Bone Graft Materials in Spine Fusion: Current Evidence and Future Trends

Plantz, Mark A.; Gerlach, Erik B.; Hsu, Wellington K.

doi:10.14444/8058

Cited by 15 publications

(29 citation statements)

References 66 publications

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“…Nevertheless, to overcome the limitations of these treatments, especially those related to the lack of availability of patient/donor tissue, synthetic or semi-synthetic materials have been demonstrated to be valid alternatives for the replacement of natural bone stock [ 16 , 17 , 18 , 19 , 20 , 21 ]. Among these, absorbable ceramics such as hydroxyapatite (HA), calcium sulphate, and tricalcium sulphate (TCP), or their combination, are commonly used as bone grafts [ 22 ].…”

Section: Introductionmentioning

confidence: 99%

An Observational Prospective Clinical Study for the Evaluation of a Collagen-Hydroxyapatite Composite Scaffold in Hip Revision Surgery

Cimatti

Andreoli

Busacca³

et al. 2022

JCM

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One of the greatest challenges of hip revision surgery is the need to restore extensive bone loss by creating a stable reconstruction with long-term durability. The present observational, investigator-initiated prospective study was carried out to evaluate the clinical and radiological results of the use of a commercial biomimetic collagen–hydroxyapatite composite biomaterial (RegenOss) applied in hip revision surgery. Thirty-three patients who underwent hip revision were included in this study, and 29 received up to 2 years of follow-up. The acetabulum was reconstructed using an uncemented hemispherical shell both with or without an iliac fixation stem. Functional recovery was assessed according to the Harris Hip Score (HHS) at the pre-hospitalisation check-up, and at 6-, 12-, and 24-month follow-ups. Radiological evaluation consisting of X-ray analyses (6, 12, and 24 month follow-ups) and CT scan exams (within 10 weeks post-surgery and at 12-month follow-up) were performed to evaluate the reduction in bone defect and new bone regeneration. All the patients reported a complete recovery and a considerable improvement in functional outcome assessed by the HHS, which was significantly higher at all the follow-ups than at pre-hospitalisation. Moreover, radiological assessments revealed good scaffold integration. Overall, collected data suggest that RegenOss is a valid and safe alternative to restoring acetabular bone loss in revision hip arthroplasty.

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Section: Introductionmentioning

confidence: 99%

An Observational Prospective Clinical Study for the Evaluation of a Collagen-Hydroxyapatite Composite Scaffold in Hip Revision Surgery

Cimatti

Andreoli

Busacca³

et al. 2022

JCM

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“…Similar to this study, the overall trend is consistent with prior literature with a decrease in separate incision autografts in favor of synthetic bone graft materials. 12,13,16 For instance, Lad et al 16 reported a decreasing utilization of iliac crest bone grafts relative to alternatives for all spinal fusion procedures examined from 1993 to 2006.…”

Section: Discussionmentioning

confidence: 99%

“…Iliac crest (separate incision autograft) has long been considered the gold standard grafting material for such procedures. [3][4][5][6] Despite this, local autograft and graft supplements/alternatives have anecdotally been increasingly relied on, 12 presumably to avoid associated complications of separate incision autograft. 5,[7][8][9][10] Numerous studies note the morbidity with harvesting of the iliac crest for autografts and shift focus to the importance of osteogenic materials on spinal fusion rates.…”

Section: Discussionmentioning

confidence: 99%

Decline in Separate Incision Autograft for Spine Surgery Over the Past Decade: A Fading “gold standard”

Rudisill

Ratnasamy

Maloy

et al. 2023

J Am Acad Orthop Surg

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Background: Spinal fusion is a common procedure for which bone grafting is a critical component. Although iliac crest (separate incision autograft) is typically referred to as the “gold standard” grafting material, it seems to be used less and less frequently. Methods: The 2010 to Q3 2020 MSpine PearlDiver data set was used to identify patients receiving separate incision autograft versus local autograft/allograft/graft supplement for spinal fusion. Grafting trends over the decade were determined. Patient age, sex, Elixhauser Comorbidity Index, smoking status, insurance plan, region of the country where the surgery was conducted, and surgeon specialty were characterized and compared by the type of bone graft using univariate and multivariate analyses. Results: Of 373,569 spinal bone grafting procedures, separate incision autografts were used for 32,401 (8.67%). A gradual decline was observed from 2010 (10.57% of spinal grafting procedures) to 2020 (4.69%, P-value < 0.00001). Independent predictors of having had a separate incision autograft in order of decreasing odds included surgeon specialty (relative to neurosurgery, orthopaedic odds ratio [OR], 2.45), smoking status (relative to nonsmokers, smokers OR, 1.45), region of the country (relative to Midwest, Northeast OR, 1.11; West OR, 1.42; and South OR, 1.48), insurance (relative to commercial, Medicare OR, 1.14), younger age (OR, 1.04 per decade increase), and lower Elixhauser Comorbidity Index (OR, 0.95 per two-point increase) (P < 0.0001 for each). Conclusion: Iliac crest autograft continues to be referred to as the gold standard grafting material for spine fusions. However, the use of this has faded over the past decade to only 4.69% of spinal fusions in 2020. While some patient factors had an effect on when separate incision autograft was used, nonsurgical factors, including surgeon specialty, geographic region where the surgery was conducted, and insurance factors, suggested that external factors/physician training influence this choice.

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“…Autologous iliac bone graft is the 'gold standard' due to its three desirable properties: osteogenicity, osteoinductivity, and osteoconductivity [ 8 , 9 ]. Nevertheless, graft harvesting can implicate higher morbidity and complications such as chronic pain at the donor site [ 10 – 12 ]. Different kinds of materials have been developed in order to promote solid fusion at the same time that reduce morbidity.…”

Section: Introductionmentioning

confidence: 99%

“…A new generation of synthetic ceramic bone graft substitutes has gained popularity as they intimately resemble natural bone with intrinsic osteoinductive properties due to their specifically engineered surface microarchitecture, designed to induce cell differentiation and drive bone fusion [ 9 , 10 ]. CBGS is a synthetic bone material composed of tricalcium phosphate (TCP) granules with a polymeric binder able to promote spinal fusions similar to autologous bone graft.…”

Section: Introductionmentioning

confidence: 99%

Ceramic bone graft substitute vs autograft in XLIF: a prospective randomized single-center evaluation of radiographic and clinical outcomes

Menezes¹,

Lacerda²,

Valle³

et al. 2022

Eur Spine J

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Purpose of the Study The objective of this prospective, parallel, randomized, single-center study is to evaluate the clinical success of a commercial ceramic bone graft substitute (CBGS) for autograft in eXtreme Lateral Interbody Fusion (XLIF) procedures. Please confirm if the author names are presented accurately and in the correct sequence (given name, middle name/initial, family name). Author 1 Given name: [Cristiano Magalhães], Last name [Menezes]. Author 2 Given name: [Gabriel Carvalho], Last name [Lacerda]. Author 5 Given name: [Erica Godinho], Last name [Menezes]. Also, kindly confirm the details in the metadata are correct.yes Methods Forty-five adult subjects were consecutively enrolled and randomized into a single-level XLIF procedure using either CBGS or iliac crest bone graft autograft (30 and 15 subjects, respectively). The primary outcome was fusion rate at 12, 18, and 24 months. Secondary outcomes were pain and disability measured by HRQOL questionnaires. Kindly check and confirm whether the corresponding author and his corresponding affiliations is correctly identified.yes Results The fusion rates for both CBGS and autograft groups at the 24-month follow-up were 96.4% and 100%, respectively. For the CBGS group, mean ODI, mean back pain, and mean worst leg pain significantly improved at the 24-month follow-up by 76.7% (39.9–9.3), 77.6% (7.3–1.6), and 81.3% (5.1–1.0), respectively. For the autograft group, mean ODI, mean back pain, and mean worst leg pain significantly improved during the same time period by 77.1% (35.9–8.2), 75.6% (6.1–1.5), and 86.0% (6.6–0.9), respectively (all time points between groups, p < 0.05). Conclusion The results of this prospective, randomized study support the use of CBGS as a standalone bone graft substitute for autograft in single-level XLIF surgery. The clinical performance and safety outcomes reported here are consistent with published evidence on CBGS. Improvements in patient-reported back pain, leg pain, and disability outcomes were comparable between the CBGS and autograft groups.

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Synthetic Bone Graft Materials in Spine Fusion: Current Evidence and Future Trends

Cited by 15 publications

References 66 publications

An Observational Prospective Clinical Study for the Evaluation of a Collagen-Hydroxyapatite Composite Scaffold in Hip Revision Surgery

An Observational Prospective Clinical Study for the Evaluation of a Collagen-Hydroxyapatite Composite Scaffold in Hip Revision Surgery

Decline in Separate Incision Autograft for Spine Surgery Over the Past Decade: A Fading “gold standard”

Ceramic bone graft substitute vs autograft in XLIF: a prospective randomized single-center evaluation of radiographic and clinical outcomes

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