Synthetic bone graft versus autograft or allograft for spinal fusion: a systematic review

The purpose of this review was to compare the efficacy and safety of synthetic bone graft substitutes versus autograft or allograft for the treatment of lumbar and cervical spinal degenerative diseases. Multiple major medical reference databases were searched for studies that evaluated spinal fusion using synthetic bone graft substitutes (either alone or with an autograft or allograft) compared with autograft and allograft. Randomized controlled trials (RCT) and cohort studies with more than 10 patients were included. Radiographic fusion, patient-reported outcomes, and functional outcomes were the primary outcomes of interest. The search yielded 214 citations with 27 studies that met the inclusion criteria. For the patients with lumbar spinal degenerative disease, data from 19 comparative studies were included: 3 RCTs, 12 prospective, and 4 retrospective studies. Hydroxyapatite (HA), HA+collagen, β-tricalcium phosphate (β-TCP), calcium sulfate, or polymethylmethacrylate (PMMA) were used. Overall, there were no differences between the treatment groups in terms of fusion, functional outcomes, or complications, except in 1 study that found higher rates of HA graft absorption. For the patients with cervical degenerative conditions, data from 8 comparative studies were included: 4 RCTs and 4 cohort studies (1 prospective and 3 retrospective studies). Synthetic grafts included HA, β-TCP/HA, PMMA, and biocompatible osteoconductive polymer (BOP). The PMMA and BOP grafts led to lower fusion rates, and PMMA, HA, and BOP had greater risks of graft fragmentation, settling, and instrumentation problems compared with iliac crest bone graft. The overall quality of evidence evaluating the potential use and superiority of the synthetic biological materials for lumbar and cervical fusion in this systematic review was low or insufficient, largely due to the high potential for bias and small sample sizes. Thus, definitive conclusions or recommendations regarding the use of these synthetic materials should be made cautiously and within the context of the limitations of the evidence.

Download Full-text

An inception cohort study of patients in a military clinic treated for lower back pain with lumbar fusion and SIGNAFUSE® with a systematic review of the literature

Surgical Case Reports ◽

10.31487/j.scr.2018.03.025 ◽

2018 ◽

Author(s):

Grant Steen

Keyword(s):

Systematic Review ◽

Bone Graft ◽

Spinal Fusion ◽

Lumbar Fusion ◽

Fusion Rate ◽

Fusion Surgery ◽

Synthetic Bone ◽

Synthetic Bone Graft ◽

Spinal Fusion Surgery ◽

Bone Graft Substitutes

Background: Use of synthetic bone graft substitutes for spinal fusion has increased sharply over the past 20 years. SIGNAFUSE® is one such synthetic graft material that provides an osteostimulatory effect for spinal fusion. Because clinical trials are not required for commercialization of synthetic bone graft substitutes in the United States, fusion rates attained using SIGNAFUSE for lumbar fusion are not well documented. The goal of the current study is to determine the rate of spinal fusion in a military clinic following lumbar fusion surgery augmented with SIGNAFUSE. Methods: We report a retrospective chart review of 8 patients who received lumbar spinal fusion surgery augmented with SIGNAFUSE. All patients were assessed by computed tomographic (CT) imaging at least 1-year post-surgery to determine whether bony fusion had occurred. We also systematically reviewed literature sources that report fusion rate following spinal fusion surgery, for broader context. Results: An average of 1.6 spinal levels were treated with SIGNAFUSE-loaded interbody cages. All patients had stabilization hardware via pedicle screws or integrated cage fixation. Seven of 8 patients successfully fused, for an overall fusion rate of 87.5% (95% confidence interval: 47.4% to 99.7%). Systematic review of 26 recent publications that included 1,126 patients treated with synthetic bone graft showed that the overall fusion rate in the literature is 84.4%. Conclusions: Fusion was achieved in 87.5% of patients treated with SIGNAFUSE. This is comparable to the fusion rate in a systematic review of 1,126 patients treated with synthetic bone graft materials.

Download Full-text

Microporosity enhances bioactivity of synthetic bone graft substitutes

Journal of Materials Science Materials in Medicine ◽

10.1007/s10856-005-6988-1 ◽

2005 ◽

Vol 16 (5) ◽

pp. 467-475 ◽

Cited By ~ 204

Author(s):

K. A. Hing ◽

B. Annaz ◽

S. Saeed ◽

P. A. Revell ◽

T. Buckland

Keyword(s):

Bone Graft ◽

Synthetic Bone ◽

Synthetic Bone Graft ◽

Bone Graft Substitutes

Download Full-text

Synthetic Bone Graft Substitutes

Otolaryngologic Clinics of North America ◽

10.1016/s0030-6665(20)30622-8 ◽

1994 ◽

Vol 27 (5) ◽

pp. 1037-1074 ◽

Cited By ~ 33

Author(s):

Peter D. Costantino ◽

Craig D. Friedman

Keyword(s):

Bone Graft ◽

Synthetic Bone ◽

Synthetic Bone Graft ◽

Bone Graft Substitutes

Download Full-text

In Vitro Elution Characteristics of Gentamicin and Vancomycin from Synthetic Bone Graft Substitutes

The Open Orthopaedics Journal ◽

10.2174/1874325001307010624 ◽

2013 ◽

Vol 7 (1) ◽

pp. 624-629 ◽

Cited By ~ 5

Author(s):

Gerrit Steffen Maier ◽

Klaus Edgar Roth ◽

Stefan Andereya ◽

Klaus Birnbaum ◽

Christopher Niedhart ◽

...

Keyword(s):

Bone Graft ◽

Bone Disease ◽

Detection Threshold ◽

Vancomycin Concentration ◽

Synthetic Bone ◽

Synthetic Bone Graft ◽

Homogeneous Particle ◽

Bone Graft Substitutes ◽

New Treatment

Objects: Beta tricalciumphosphate pellets loaded with individualized antibiotics may represent novel options in the treatment of osteomyelitis and infectious bone disease. Here, the in vitro antibiotic elution of vancomycin and gentamicin from the synthetic bone graft substitutes Cerasorb® and Cerasorb M® was tested. Methods: Antibiotic elution and concentration of gentamcin and vancomycin were measured using photometrically-based measurement and homogeneous particle-enhanced turbidimetric inhibition immunoassays (PETINIA). Results: Initially both materials showed a high release of the loaded antibiotics, with Cerasorb M® showing lower release levels for gentamicin and vancomycin than Cerasorb®. Gentamicin concentrations of Cerasorb M granules and Cerasorb were below the minimum detectiontreshold until day four and six of the experiment respectively. The vancomycin release-level followed a similar pattern, although the vancomycin concentration eluted by Cerasorb M® granules stayed above the detection threshold during the experimental time. Conclusions: Cerasorb® and Cersorb M® may represent a new treatment option in osteomyelitis and infectious bone disease.

Download Full-text