Use of demineralized bone matrix in spinal fusion

Abstract

Spinal fusion remains the gold-standard treatment for several pathological spine conditions. Although, autologous Iliac Crest Bone Grafting is considered the gold-standard 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.

Growth factors in orthopaedic surgery: demineralized bone matrix versus recombinant bone morphogenetic proteins

“…Using DBM as an extender makes those protocols less reliable as the association with more or less local autologous graft or ICA is not accurate. No difference between DBM and autograft was observed in those studies and they confirm the utility of DBM as graft extender [32,33]. …”

Duchenne muscular dystrophy: the management of scoliosis

“…One article suggests the role of allograft bone, as this reduces the risks associated with autogenous bone collection but still provides the required osteoinductive activity (63). A more recent review article highlighted the move within spinal surgery to using demineralised bone matrix as this removes the donor site morbidity while still providing a satisfactory fusion (64).…”

Mandibular defect reconstruction utilizing preoperative 3D modeling, plate pre-bending and a novel triad graft: a case report

“…Fortunately, DBM diminishes the need for large amounts of autogenous cancellous bone. [18] Grafton ® is a proprietary form of DBM that retains growth factors and has been shown to induce new bone formation. [19,20] DBM is a readily available graft material that can be processed to retain both osteoconductive and osteoinductive characteristics.…”