Osteoinductive bone graft substitutes for lumbar fusion: a systematic review

Object Autograft and allograft, the standard approaches for lumbar fusion procedures, have important disadvantages. Bone graft substitutes such as recombinant human bone morphogenetic proteins (rhBMP-2 and rhBMP-7) have emerged as viable alternatives. The authors conducted a systematic review to compare the efficacy and safety of osteoinductive bone graft substitutes using autografts and allografts in lumbar fusion. Methods A search for prospective controlled trials was conducted on MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials databases. Data were extracted for key outcomes including radiographically demonstrated nonunion, Oswestry Disability Index, operating time, blood loss, and length of hospital stay. The quality of randomized controlled trials was assessed using the Jadad scale. Meta-analyses were performed when feasible, and heterogeneity was assessed using the Q statistic and the I2 statistic. Results Seventeen of 732 potential studies met the inclusion criteria, with 9 examining rhBMP-2, 3 examining rhBMP-7, 3 examining demineralized bone matrix, and 2 examining autologous growth factor. Recombinant human BMP-2 significantly decreased radiographic nonunion when compared with autologous iliac crest bone graft (AIBG) in a meta-analysis (relative risk 0.27, 95% CI 0.16–0.46). Stratification of meta-analyses by the type of surgical procedure performed yielded similar results. Funnel plots suggested publication bias. Trials of rhBMP-2 suggested reductions in the operating time and surgical blood loss, with less effect on the length of hospital stay. There was no difference in radiographic nonunion with the use of rhBMP-7 when compared with AIBG (relative risk 1.02, 95% CI 0.52–1.98). Neither rhBMP-2 nor rhBMP-7 demonstrated a significant improvement on the Oswestry Disability Index when compared with AIBG. The limited data on demineralized bone matrix and autologous growth factor showed no significant improvement in radiographic outcomes. Conclusions Recombinant human BMP-2 may be an effective alternative to AIBG in lumbar fusion. Data are limited for other bone graft substitutes.

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

Current Drug Delivery ◽

10.2174/1567201815666181024142354 ◽

2018 ◽

Vol 16 (2) ◽

pp. 94-110 ◽

Cited By ~ 4

Author(s):

Guanbao Li ◽

Pinquan Li ◽

Qiuan Chen ◽

Hnin Ei Thu ◽

Zahid Hussain

Keyword(s):

Bone Graft ◽

Spinal Fusion ◽

Bone Grafting ◽

Demineralized Bone Matrix ◽

Donor Site ◽

Bone Matrix ◽

Great Promise ◽

Level Of Evidence ◽

Bone Fusion ◽

Bone Graft Substitutes

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.

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Experimental study on demineralized bone matrix (DBM) and coral as bone graft substitutes in maxillofacial surgery

International Journal of Oral and Maxillofacial Surgery ◽

10.1016/s0901-5027(05)80028-1 ◽

1994 ◽

Vol 23 (6) ◽

pp. 395-398 ◽

Cited By ~ 18

Author(s):

L. Dupoirieux ◽

V. Costes ◽

P. Jammet ◽

F. Souyris

Keyword(s):

Experimental Study ◽

Bone Graft ◽

Demineralized Bone Matrix ◽

Bone Matrix ◽

Maxillofacial Surgery ◽

Bone Graft Substitutes ◽

Demineralized Bone

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A Historical Review of Common Bone Graft Materials in Foot and Ankle Surgery

Foot & Ankle Specialist ◽

10.1177/1938640013516358 ◽

2014 ◽

Vol 7 (2) ◽

pp. 143-151 ◽

Cited By ~ 18

Author(s):

Justin W. Arner ◽

Robert D. Santrock

Keyword(s):

Bone Graft ◽

Demineralized Bone Matrix ◽

Donor Site ◽

Bone Matrix ◽

Historical Review ◽

Donor Site Morbidity ◽

Iliac Crest Bone Graft ◽

Foot And Ankle ◽

Ankle Surgery ◽

Bone Graft Substitutes

Foot and ankle fusion is an important treatment for arthritis and deformities of the ankle and hindfoot. The literature has shown that there are improvements in fusion rates with the addition of bone graft and bone graft substitutes. Today autografts, specifically the iliac crest bone graft (ICBG), continue to be the gold standard despite significant donor site morbidity and nonunion rates, persisting around 10%. To address these drawbacks, bone graft substitutes have been developed. This article includes a historical review of the use, outcomes, and safety of autografts, allografts, and bone graft substitutes, such as ceramics, demineralized bone matrix, and platelet-derived growth factor.

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ROLE OF BONE GRAFTS AND BONE GRAFT SUBSTITUTES IN ISOLATED SUBTALAR JOINT ARTHRODESIS

Acta Ortopédica Brasileira ◽

10.1590/1413-785220172505177665 ◽

2017 ◽

Vol 25 (5) ◽

pp. 183-187 ◽

Cited By ~ 5

Author(s):

ASHISH SHAH ◽

SAMEER NARANJE ◽

IBUKUNOLUWA ARAOYE ◽

OSAMA ELATTAR ◽

ALEXANDRE LEME GODOY-SANTOS ◽

...

Keyword(s):

Bone Graft ◽

Demineralized Bone Matrix ◽

Bone Matrix ◽

Case Series ◽

Bone Grafts ◽

Union Rate ◽

Level Of Evidence ◽

Subtalar Arthrodesis ◽

Significant Difference ◽

Bone Graft Substitutes

ABSTRACT Objectives: The purpose of this study was to compare union rates for isolated subtalar arthrodesis with and without the use of bone grafts or bone graft substitutes. Methods: We retrospectively reviewed 135 subtalar fusions with a mean follow-up of 18 ± 14 months. The standard approach was used for all surgeries. Graft materials included b-tricalcium phosphate, demineralized bone matrix, iliac crest autograft and allograft, and allograft cancellous chips. Successful subtalar fusion was determined clinically and radiographically. Results: There was an 88% (37/42) union rate without graft use and an 83% (78/93) union rate with bone graft use. Odds ratio of union for graft versus no graft was 0.703 (95% CI, 0.237-2.08). The average time to union in the graft group was 3 ± 0.73 months and 3 ± 0.86 in the non-graft group, with no statistically significant difference detected (p = 0.56). Conclusion: Graft use did not improve union rates for subtalar arthrodesis. Level of Evidence IV, Case Series.

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Comparison of Calcium Phosphate Bone Graft Substitutes with Demineralized Bone Matrix Graft Substitutes

Frontiers in Bioengineering and Biotechnology ◽

10.3389/conf.fbioe.2016.01.01469 ◽

2016 ◽

Vol 4 ◽

Author(s):

Samizadeh Sorousheh ◽

Coathup Melanie ◽

Hing Karin ◽

Blunn Gordon W

Keyword(s):

Calcium Phosphate ◽

Bone Graft ◽

Demineralized Bone Matrix ◽

Bone Matrix ◽

Bone Graft Substitutes ◽

Demineralized Bone

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Comparative Assessment of Autogenous Cancellous Bone Graft and Bovine-Derived Demineralized Bone Matrix for Secondary Alveolar Bone Grafting in Patients With Unilateral Cleft Lip and Palate

The Cleft Palate-Craniofacial Journal ◽

10.1177/10556656211025197 ◽

2021 ◽

pp. 105566562110251

Author(s):

Vijay Kumar ◽

Vidya Rattan ◽

Sachin Rai ◽

Satinder Pal Singh ◽

Jai Kumar Mahajan

Keyword(s):

Bone Graft ◽

Iliac Crest ◽

Demineralized Bone Matrix ◽

Bone Matrix ◽

Volumetric Analysis ◽

Group I ◽

Alveolar Bone Grafting ◽

Group Ii ◽

Demineralized Bone

Objective: Comparison between bovine-derived demineralized bone matrix (DMBM) and iliac crest graft over long term for secondary alveolar bone grafting (SABG) in patients with unilateral cleft lip and palate (UCLP) in terms of radiological and clinical outcomes. Design: Prospective, randomized, parallel groups, double-blind, controlled trial. Setting: Unit of Oral and Maxillofacial Surgery, Oral Health Science Centre, Postgraduate Institute of Medical Education & Research, Chandigarh. Participants: Twenty patients with UCLP. Interventions: Patients were allocated into group I (Iliac crest bone graft) and group II (DMBM) for SABG. Outcomes were assessed at 2 weeks, 6 months, and then after mean follow-up period of 63 months. Outcomes Measures: Volumetric analysis of the grafted bone in the alveolar cleft site was done through cone beam computed tomography using Cavalieri principle and modified assessment tool. Clinical assessment was performed in terms of pain, swelling, duration of hospital stay, cost of surgery, alar base symmetry, and donor site morbidity associated with iliac crest harvesting. Results: Volumetric analysis through Cavalieri principle revealed comparable bone uptake at follow-up of 6 months between group I (70%) and group II (69%). Modified assessment tool showed no significant difference between horizontal and vertical bone scores over short- and long-term follow-up. In group II, there was higher cost of surgery, but no donor site morbidity unlike group I. Conclusions: Demineralized bone matrix proved analogous to iliac crest bone graft as per volumetric analysis over shorter period. However, although statistically insignificant, net bone volume achieved was lower than the iliac crest graft at longer follow-up.

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