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Li J, Zhao B, Wang W, Xu Y, Wu H, Zhang W. Improved intervertebral fusion in LLIF rabbit model with a novel titanium cage. Spine J 2024; 24:1109-1120. [PMID: 38211901 DOI: 10.1016/j.spinee.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/20/2023] [Accepted: 12/27/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND CONTEXT There is no established small animal approach model for the strict simulation of lateral lumbar interbody fusion (LLIF) surgery. PURPOSE This study aims to establish a reliable LLIF rabbit model that strictly simulates the procedure and to preliminarily evaluate the differences in fusion outcomes with different graft materials. STUDY DESIGN A controlled laboratory. METHODS Fifty-four 4-month-old white New Zealand female and male rabbits were selected and divided into five groups: Group A (dissection group) consisted of 9 rabbits, Group B (normal approach group) consisted of 9 rabbits, Group C (autogenous iliac bone group) consisted of 12 rabbits, Group D (BMP-2 carrier material group) consisted of 12 rabbits, and Group E (allograft bone group) consisted of 12 rabbits. Based on data from Group A, a novel titanium metal fusion device was designed. Postoperatively, at the 12-week mark, manual palpation was employed to compare the interbody fusion status among Groups B, C, D, and E. Specimens from Groups C, D, and E were subjected to Micro-CT scanning to compare various parameters such as trabecular bone volume (BV), bone volume fraction (BV/TV, BVF), and bone surface area (BS). Furthermore, a tissue histopathological examination was performed to observe the structure and morphology of newly formed bone within the fusion mass as well as the remodeling of the graft in each group. RESULTS Based on the measurements obtained from the dissection group, we designed a U-shaped interbody fusion device with dimensions of 10 mm in length, 2.5 mm in width, and 1.3 mm in height. In Group B, 9 cases exhibited intervertebral mobility. In Group C, 1 case showed nonfusion. In Group D, all cases achieved fusion. In Group E, 4 cases did not achieve fusion. Additionally, the Micro-CT results showed that the interbody fusion index scores were 4.64±0.50 in Group C, 4.33±0.65 in Group D, and 3.36±0.81 in Group E. There was no statistically significant difference in fusion index scores between Groups C and D (p=.853). Notably, Groups C and D had higher scores than Group E (p<.001). The trabecular bone volume (BV) in Groups C and D also showed no significant difference but was significantly higher than in Group E (p<.001). Furthermore, the histopathological results revealed that the specimens from Group E had less newly formed cartilage and bone compared to Groups C and D. CONCLUSIONS This study successfully established a strict simulation of the clinical LLIF procedure in a rabbit model. Moreso, we conducted a preliminary validation indicating that the BMP-2 carrier material achieved interbody fusion outcomes similar to autogenous iliac bone. CLINICAL SIGNIFICANCE The findings of this investigation from animal models provide a theoretical basis for the clinical use of BMP-2 to promote early spinal fusion in LLIF procedures. Importantly, the study provides a small animal model foundation for research related to LLIF surgery.
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Affiliation(s)
- Jiaqi Li
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Bingyi Zhao
- Department of Reproductive and Genetic medicine, Hebei General Hospital, Shijiazhuang, 050000, China
| | - Weijian Wang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Yafei Xu
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Haoyu Wu
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Wei Zhang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050000, China.
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Miron RJ. Optimized bone grafting. Periodontol 2000 2024; 94:143-160. [PMID: 37610202 DOI: 10.1111/prd.12517] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 08/24/2023]
Abstract
Bone grafting is routinely performed in periodontology and oral surgery to fill bone voids. While autogenous bone is considered the gold standard because of its regenerative properties, allografts and xenografts have more commonly been utilized owing to their availability as well as their differential regenerative/biomechanical properties. In particular, xenografts are sintered at high temperatures, which allows for their slower degradation and resorption rates and/or nonresorbable features. As a result, clinicians have combined xenografts with other classes of bone grafts (most notably allografts and autografts in various ratios) for procedures requiring better long-term stability, such as contour grafting, sinus elevation procedures, and vertical bone augmentations. This review addresses the regenerative properties of each class of bone grafts and then highlights the importance of understanding each of their biomechanical and regenerative properties for clinical applications, including extraction site management, contour augmentation, sinus grafting, and horizontal and vertical augmentation procedures. Thereafter, an introduction toward the novel production of nonresorbable bone allografts (NRBAs) via high-temperature sintering is presented. These NRBAs not only pose the advantage of being more biocompatible than xenografts owing to their origin (human vs. animal bone) but also display nonresorbable properties similar to those of xenografts. Thus, while packaging allografts with xenografts in premixtures specific to various clinical indications has never been permitted owing to cross-species contamination and FDA/CE requirements, the discovery and production of NRBAs allows premixing with standard allografts in various ratios without regulatory restrictions. Therefore, premixtures of allografts with NRBAs can be produced in various ratios for specific indications (e.g., a 1:1 ratio similar to an allograft/xenograft mixture for sinus grafting) without the need for purchasing separate classes of bone grafts. This optimized form of bone grafting could theoretically provide clinicians more precise ratios without the need to purchase separate bone grafts. This review highlights the future potential for simplified and optimized bone grafting in periodontology and implant dentistry.
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Affiliation(s)
- Richard J Miron
- Department of Periodontology, University of Bern, Bern, Switzerland
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Lee BJ, Seok MC, Koo HW, Jeong JH, Ko MJ. Bone Substitute Options for Spine Fusion in Patients With Spine Trauma-Part I: Fusion Biology, Autografts, Allografts, Demineralized Bone Matrix, and Ceramics. Korean J Neurotrauma 2023; 19:446-453. [PMID: 38222832 PMCID: PMC10782097 DOI: 10.13004/kjnt.2023.19.e62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/03/2023] [Accepted: 12/06/2023] [Indexed: 01/16/2024] Open
Abstract
Spinal trauma accounts for a large portion of injuries to the spine area, particularly as societies are entering an era of aging populations. Consequently, spine fractures accompanied by osteoporosis are becoming more prevalent. Achieving successful fusion surgery in patients with spine fractures associated with osteoporosis is even more challenging. Pseudarthrosis in the spine does not yield clinically favorable results; however, considerable effort has been made to achieve successful fusion, and the advancement of bone graft substitutes has been particularly crucial in this regard. Autograft bone is considered the best fusion material but is limited in use due to the quantity that can be harvested during surgery and associated complications. Accordingly, various bone graft substitutes are currently being used, although no specific guidelines are available and this mainly depends on the surgeon's choice. Therefore, the purpose of this review, across part I/II, is to summarize bone graft substitutes commonly used in spine surgery for spine fusion in patients with spine trauma and to update the latest knowledge on the role of recombinant human bone morphogenetic protein-2.
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Affiliation(s)
- Byung-Jou Lee
- Department of Neurosurgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Min cheol Seok
- Department of Neurosurgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Hae-Won Koo
- Department of Neurosurgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Je Hoon Jeong
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Myeong Jin Ko
- Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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Smith KA, Russo GS, Vaccaro AR, Arnold PM. Scientific, Clinical, Regulatory, and Economic Aspects of Choosing Bone Graft/Biological Options in Spine Surgery. Neurosurgery 2020; 84:827-835. [PMID: 30032187 DOI: 10.1093/neuros/nyy322] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/17/2018] [Indexed: 01/07/2023] Open
Abstract
Spinal arthrodesis is a major element of the spinal surgeon's practice. To attain successful fusion rates, attention must be paid to spinal segment immobilization and proper selection of bone graft. Autogenous bone graft (ie, ICBG), the "gold standard," with or without graft extenders and enhancers provides the foundation for most spinal fusions. ABG is the only graft option containing all 3 factors of new bone growth: osteoconductivity, osteoinductivity, and osteogenicity. While many bone graft alternatives function well as bone graft extenders, only growth factors proteins (ie, rhBMP-2 or OP-2) function as bone graft enhancers and substitutes. The search for optimal hybrid interbody cages, bone graft substitutes, autogenous or allogenic stem cells, and nanostructure scaffolds for release of growth factors continues.
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Affiliation(s)
- Kyle A Smith
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Glenn S Russo
- Department of Orthopedics, Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Alexander R Vaccaro
- Department of Orthopedics, Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Paul M Arnold
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas
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Thong FY, Mansor A, Ramalingam S, Yusof N. Does bone marrow aspirate help enhance the integration of gamma irradiated allograft bone? Cell Tissue Bank 2020; 21:107-117. [PMID: 31894432 DOI: 10.1007/s10561-019-09804-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 12/16/2019] [Indexed: 11/29/2022]
Abstract
Bone allografts donated by other individuals offer a viable alternative to autograft. Risks of disease transmission are overcome by sterilizing the bone; unfortunately sterilization methods generally affect bone functional properties including osteogenic potential and biomechanical integrity. This study aimed to determine any enhancement effect when gamma sterilised allografts was impregnated with autologous bone marrow in improving the rate and quality of integration in metaphyseal-tibial defects of rabbits. Almost all subjects showed 50% of the defect being covered by new bones by the third week and smaller residual defect size in the treated group at the fifth week. Hounsfield units at the defect site showed increasing healing in all samples, with the treated group having an apparent advantage although insignificant (p > 0.05). In the histopathological score evaluating healing over cortical and cancellous bone at the fracture site showed only slight variations between the groups (p > 0.05). Therefore no enhanced healing by the autologous bone marrow was observed when added to the bone allografts in treating the unicortical defects.
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Affiliation(s)
- Fu Yuen Thong
- Bone Bank, National Orthopaedic Centre of Excellence in Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Azura Mansor
- Bone Bank, National Orthopaedic Centre of Excellence in Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Saravana Ramalingam
- Bone Bank, National Orthopaedic Centre of Excellence in Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Norimah Yusof
- Bone Bank, National Orthopaedic Centre of Excellence in Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
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Obeid BA. Implants and grafts used in fractures for early healing. JOURNAL OF ORTHOPAEDICS AND SPINE 2020. [DOI: 10.4103/joas.joas_45_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Verifying measurements of residual calcium content in demineralised cortical bone. Cell Tissue Bank 2019; 20:527-534. [PMID: 31456097 DOI: 10.1007/s10561-019-09785-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 01/29/2019] [Accepted: 08/22/2019] [Indexed: 10/26/2022]
Abstract
Calcium contents of demineralised human cortical bone determined by titrimetric assay and atomic absorption spectrophotometry technique were verified by comparing to neutron activation analysis which has high recovery of more than 90%. Conversion factors determined from the comparison is necessary to correct the calcium content for each technique. Femurs from cadaveric donors were cut into cortical rings and demineralised in 0.5 M hydrochloric acid for varying immersion times. Initial calcium content in the cortical bone measured by titration was 4.57%, only 21% of the measurement by neutron activation analysis; while measured by atomic absorption spectrophotometer was 13.4%, only 61% of neutron activation analysis. By comparing more readings with the measurements by neutron activation analysis with 93% recovery, a conversion factor of 4.83 was verified and applied for the readings by titration and 1.45 for atomic absorption spectrophotometer in calculating the correct calcium contents. The residual calcium content started to reduce after the cortical bone was demineralised in hydrochloric acid for 8 h and reduced to 13% after 24 h. Using the linear relationship, the residual calcium content could be reduced to less than 8% after immersion in hydrochloric acid for 40 h. Atomic absorption spectrophotometry technique is the method of choice for calcium content determination as it is more reliable compared to titrimetric assay.
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Sohn HS, Oh JK. Review of bone graft and bone substitutes with an emphasis on fracture surgeries. Biomater Res 2019; 23:9. [PMID: 30915231 PMCID: PMC6417250 DOI: 10.1186/s40824-019-0157-y] [Citation(s) in RCA: 277] [Impact Index Per Article: 46.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 02/21/2019] [Indexed: 12/20/2022] Open
Abstract
Background Autogenous bone graft is the gold standard bone graft material. However, due to limitations of supply and morbidity associated with autograft harvest, various bone substitutes have been considered. This article aims to review the properties of the bone graft and various bone substitutes currently available in orthopedic surgery. Main body Synthetic bone substitutes consist of hydroxyapatite, tricalcium phosphate, calcium sulfate, or a combination of these minerals. Synthetic porous substitutes share several advantages over allografts, including unlimited supply, easy sterilization, and storage. However, they also have some disadvantages, such as brittle properties, variable rates of resorption, and poor performance in some clinical conditions. Recently, attention has been drawn to osteoinductive materials, such as demineralized bone matrix and bone morphogenetic proteins. Conclusion Despite tremendous efforts toward developing autograft alternatives, a single ideal bone graft substitute has not been developed. The surgeon should understand the properties of each bone graft substitute to facilitate appropriate selection in each specific clinical situation.
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Affiliation(s)
- Hoon-Sang Sohn
- 2Department of Orthopaedic Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Jong-Keon Oh
- 1Department of Orthopaedic Surgery, Guro Hospital, Korea University College of Medicine, 80 Guro 2-dong, Guro-gu, Seoul 152-703 South Korea
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9
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Tissue Engineered Bone Differentiated From Human Adipose Derived Stem Cells Inhibit Posterolateral Fusion in an Athymic Rat Model. Spine (Phila Pa 1976) 2018; 43:533-541. [PMID: 28816826 PMCID: PMC5812848 DOI: 10.1097/brs.0000000000002384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Biological augmentation spinal arthrodesis trial in athymic rats. OBJECTIVE To assess the efficacy of tissue-engineered bone to promote L4-L5 intertransverse process fusion in an athymic rat model. SUMMARY OF BACKGROUND DATA Each year in the United States, over 400,000 spinal fusion surgeries are performed requiring bone graft. The current gold standard for posterolateral lumbar fusion is autogenous iliac crest bone graft (ICBG), but the harvesting of ICBG is associated with increased operative time and significant complications. This being the case, an alternative cost-effective bone graft source is needed. METHODS Bovine bone cores were sterilized and decellularized for scaffold production. Human adipose derived mesenchymal stem cells (ADSC) were obtained and verified by tridifferentiation testing and seeded onto dried scaffolds. The seeded cores were cultured for 5 weeks in culture medium designed to mimic endochondral ossification and produce hypertrophic chondrocytes. Single-level intertransverse process fusions were performed at the L4-L5 level of 31 athymic rats. Fifteen rats were implanted with the hypertrophic chondrocyte seeded scaffold and 16 had scaffold alone. Half of the study rats were sacrificed at 3 weeks and the other half at 6 weeks. Spinal fusion was assessed using 2D and 3D micro computed tomography (μCT) analysis and tissue histology. RESULTS At 3 weeks, none of the tissue engineered rats had partial or complete fusion, whereas 62.5% of the decellularized rats fused and another 12.5% had partial fusions (P = 0.013). At 6 weeks, none of the tissue engineered rats fused and 50% had partial fusions, whereas 87.5% of the decellularized rats fused (P = 0.002). CONCLUSION Tissue engineered bone composed of hypertrophic chondrocytes inhibits posterolateral fusion in an athymic rat model and therefore does not represent a promising cost-effective bone graft substitute. LEVEL OF EVIDENCE N/A.
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Patterson TE, Boehm C, Nakamoto C, Rozic R, Walker E, Piuzzi NS, Muschler GF. The Efficiency of Bone Marrow Aspiration for the Harvest of Connective Tissue Progenitors from the Human Iliac Crest. J Bone Joint Surg Am 2017; 99:1673-1682. [PMID: 28976432 PMCID: PMC5621565 DOI: 10.2106/jbjs.17.00094] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The rational design and optimization of tissue engineering strategies for cell-based therapy requires a baseline understanding of the concentration and prevalence of osteogenic progenitor cell populations in the source tissues. The aim of this study was to (1) define the efficiency of, and variation among individuals in, bone marrow aspiration as a means of osteogenic connective tissue progenitor (CTP-O) harvest compared with harvest from iliac cancellous bone, and (2) determine the location of CTP-Os within native cancellous bone and their distribution between the marrow-space and trabecular-surface tissue compartments. METHODS Eight 2-mL bone marrow aspiration (BMA) samples and one 7-mm transcortical biopsy sample were obtained from the anterior iliac crest of 33 human subjects. Two cell populations were obtained from the iliac cancellous bone (ICB) sample. The ICB sample was placed into αMEM (alpha-minimal essential medium) with antibiotic-antimycotic and minced into small pieces (1 to 2 mm in diameter) with a sharp osteotome. Cells that could be mechanically disassociated from the ICB sample were defined as marrow-space (IC-MS) cells, and cells that were disassociated only after enzymatic digestion were defined as trabecular-surface (IC-TS) cells. The 3 sources of bone and marrow-derived cells were compared on the basis of cellularity and the concentration and prevalence of CTP-Os through colony-forming unit (CFU) analysis. RESULTS Large variation was seen among patients with respect to cell and CTP-O yield from the IC-MS, IC-TS, and BMA samples and in the relative distribution of CTP-Os between the IC-MS and IC-TS fractions. The CTP-O prevalence was highest in the IC-TS fraction, which was 11.4-fold greater than in the IC-MS fraction (p < 0.0001) and 1.7-fold greater than in the BMA fraction. However, the median concentration of CTP-Os in the ICB (combining MS and TS fractions) was only 3.04 ± 1.1-fold greater than that in BMA (4,265 compared with 1,402 CTP/mL; p = 0.00004). CONCLUSIONS Bone marrow aspiration of a 2-mL volume at a given needle site is an effective means of harvesting CTP-Os, albeit diluted with peripheral blood. However, the median concentration of CTP-Os is 3-fold less than from native iliac cancellous bone. The distribution of CTP-Os between the IC-MS and IC-TS fractions varies widely among patients. CLINICAL RELEVANCE Bone marrow aspiration is an effective means of harvesting CTP-Os but is associated with dilution with peripheral blood. Overall, we found that 63.5% of all CTP-Os within iliac cancellous bone resided on the trabecular surface; however, 48% of the patients had more CTP-Os contributed by the IC-MS than the IC-TS fraction.
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Affiliation(s)
- Thomas E. Patterson
- Departments of Orthopaedic Surgery (T.E.P., N.S.P., and G.F.M.) and Biomedical Engineering (T.E.P., C.B., C.N., R.R., E.W., N.S.P., and G.F.M.), Cleveland Clinic, Cleveland, Ohio,E-mail address for T.E. Patterson:
| | - Cynthia Boehm
- Departments of Orthopaedic Surgery (T.E.P., N.S.P., and G.F.M.) and Biomedical Engineering (T.E.P., C.B., C.N., R.R., E.W., N.S.P., and G.F.M.), Cleveland Clinic, Cleveland, Ohio,E-mail address for C. Boehm:
| | - Chizu Nakamoto
- Departments of Orthopaedic Surgery (T.E.P., N.S.P., and G.F.M.) and Biomedical Engineering (T.E.P., C.B., C.N., R.R., E.W., N.S.P., and G.F.M.), Cleveland Clinic, Cleveland, Ohio,E-mail address for C. Nakamoto:
| | - Richard Rozic
- Departments of Orthopaedic Surgery (T.E.P., N.S.P., and G.F.M.) and Biomedical Engineering (T.E.P., C.B., C.N., R.R., E.W., N.S.P., and G.F.M.), Cleveland Clinic, Cleveland, Ohio,E-mail address for R. Rozic:
| | - Esteban Walker
- Departments of Orthopaedic Surgery (T.E.P., N.S.P., and G.F.M.) and Biomedical Engineering (T.E.P., C.B., C.N., R.R., E.W., N.S.P., and G.F.M.), Cleveland Clinic, Cleveland, Ohio,E-mail address for E. Walker:
| | - Nicolas S. Piuzzi
- Departments of Orthopaedic Surgery (T.E.P., N.S.P., and G.F.M.) and Biomedical Engineering (T.E.P., C.B., C.N., R.R., E.W., N.S.P., and G.F.M.), Cleveland Clinic, Cleveland, Ohio,E-mail address for N.S. Piuzzi:
| | - George F. Muschler
- Departments of Orthopaedic Surgery (T.E.P., N.S.P., and G.F.M.) and Biomedical Engineering (T.E.P., C.B., C.N., R.R., E.W., N.S.P., and G.F.M.), Cleveland Clinic, Cleveland, Ohio,E-mail address for G.F. Muschler:
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Abstract
The management of long bone defects continues to be associated with significant challenges for optimum and timely bone repair. When bone grafting is needed, essential parameters to be addressed include adequate volume, optimum density, and structural capacity as well as potent biological properties. Although the autologous iliac crest bone graft remains the gold standard, its reduced availability and donor site morbidity have made the clinicians to seek for other alternative options. Reamer irrigator aspirator graft with materials used as graft expanders along with inductive molecules and cellular augmentation constitute the current trend for optimum bone regeneration. This article presents the contemporary thinking of the biological facet of segmental bone loss reconstruction.
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Kirschner Wire and Bone Cement is a Viable Alternative to Reconstruction of Large Iliac Bone Defects After Strut Bone Graft Harvesting. Clin Spine Surg 2017; 30:308-313. [PMID: 28746126 DOI: 10.1097/bsd.0000000000000254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE To assess the safety and efficacy of iliac crest defect reconstruction using Kirschner wire (K-wire)/polymethylmethacrylate (PMMA) versus traditional autologous rib graft reconstruction. SUMMARY OF BACKGROUND DATA The iliac crest has been the preferred donor site for strut bone graft for various spinal fusion surgeries. METHODS Seventy-three patients (44 males and 29 females; average age: 57.2 y) were divided into 2 groups: the rib group (35 patients) and the K-wire/PMMA group (38 patients). All operations involved anterior spinal interbody fusion. Patients were followed-up, on average, for 34.2 months using plain radiographs and both pain and cosmesis visual analog scales (VAS) to assess the clinical results after surgery. RESULTS Almost all patients had pain VAS scores of ≤1 and grade 1 cosmesis VAS scores with no significant difference between the 2 groups in terms of either pain or cosmesis (P=1.00 and 0.505, respectively). In addition, few complications were noted in both groups. Radiographic complications in the rib group and the K-wire group numbered 4 (11%) and 2 (5%), respectively; however, did not significantly differ between the 2 groups (P=0.418). One case required intraoperative revision of the length of the K-wire and 1 case needed reoperation for iliac ring fracture and K-wire migration. An additional case required revision due to a bad fall. CONCLUSIONS K-wire and bone cement reconstruction is an effective and safe alternative method for large iliac bone defect repair when autologous rib graft is not available.
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Pesenti S, Ghailane S, Varghese JJ, Ollivier M, Peltier E, Choufani E, Bollini G, Blondel B, Jouve JL. Bone substitutes in adolescent idiopathic scoliosis surgery using sublaminar bands: is it useful? A case-control study. INTERNATIONAL ORTHOPAEDICS 2017; 41:2083-2090. [PMID: 28540414 DOI: 10.1007/s00264-017-3512-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 05/07/2017] [Indexed: 12/20/2022]
Abstract
INTRODUCTION In order to avoid pseudarthrosis in adolescent idiopathic (AIS) patients, it is recommended to bring additional bone graft or substitute. Modern rigid instrumentations have been shown to provide less pseudarthroses even without bone substitutes. The aim of our study was to determine the impact of using bones substitutes on fusion rates in adolescent idiopathic scoliosis patients undergoing PSF with sublaminar bands. METHOD AIS patients scheduled to undergo PSF with sublaminar bands were prospectively enrolled into this study and not given any bone substitutes (no-substitute group). Data were collected and analyzed in patients with at least two years of follow-up. Pseudarthrosis was diagnosed if at least one of the following was present: persistent back pain, hardware failure, loss of correction greater than 10°. The results were compared to a control group who received bone substitutes for the same surgical procedure. RESULTS Eighty-eight patients were included. For the whole cohort, the mean age was 14.8 years old and the mean follow-up was 30.9 months. For the 'no-substitute' group (n = 44), the mean Cobb angle was 56° pre-operatively, 20.1° post-operatively, and 22° at final follow-up. The fusion rate was not statistically different between the two groups (97.7% vs 95.5%, p = 0.56). At last follow-up, one pseudarthrosis occurred in the 'no substitute' group and two in the control group. DISCUSSION This is the first study to determine the impact of bone substitutes in AIS fusion using sublaminar bands. In our study, the use of local autologous bone graft alone resulted in a fusion rate of 97.7% despite the use of more flexible instrumentation. The high rate of fusion in AIS patients is more probably due to the healing potential of these young patients rather than to the type of instrumentation. CONCLUSION The use of additional bone graft or bone substitutes may not be mandatory when managing AIS. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Sebastien Pesenti
- Spine Research Laboratory, Hospital for Special Surgery, New York, NY, USA. .,Aix Marseille Univ, CNRS, ISM, Inst Movement Sci, Marseille, France. .,Pediatric Orthopaedics, Timone Enfants, Aix-Marseille University, 264 rue Saint Pierre, 13005, Marseille, France.
| | - Soufiane Ghailane
- Pediatric Orthopaedics, Timone Enfants, Aix-Marseille University, 264 rue Saint Pierre, 13005, Marseille, France
| | - Jeffrey J Varghese
- Spine Research Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - Matthieu Ollivier
- Pediatric Orthopaedics, Timone Enfants, Aix-Marseille University, 264 rue Saint Pierre, 13005, Marseille, France
| | - Emilie Peltier
- Pediatric Orthopaedics, Timone Enfants, Aix-Marseille University, 264 rue Saint Pierre, 13005, Marseille, France
| | - Elie Choufani
- Pediatric Orthopaedics, Timone Enfants, Aix-Marseille University, 264 rue Saint Pierre, 13005, Marseille, France
| | - Gerard Bollini
- Pediatric Orthopaedics, Timone Enfants, Aix-Marseille University, 264 rue Saint Pierre, 13005, Marseille, France
| | - Benjamin Blondel
- Aix Marseille Univ, CNRS, ISM, Inst Movement Sci, Marseille, France.,Spine Unit, Timone, Aix-Marseille University, 264 rue St Pierre, 13005, Marseille, France
| | - Jean-Luc Jouve
- Pediatric Orthopaedics, Timone Enfants, Aix-Marseille University, 264 rue Saint Pierre, 13005, Marseille, France
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14
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Lee S, Shen J, Pan HC, Shrestha S, Asatrian G, Nguyen A, Meyers C, Nguyen V, Lee M, Soo C, Ting K, James AW. Calvarial Defect Healing Induced by Small Molecule Smoothened Agonist. Tissue Eng Part A 2016; 22:1357-1366. [PMID: 27702396 DOI: 10.1089/ten.tea.2016.0167] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Hedgehog (Hh) signaling positively regulates both endochondral and intramembranous ossification. Use of small molecules for tissue engineering applications poses several advantages. In this study, we examined whether use of an acellular scaffold treated with the small molecule Smoothened agonist (SAG) could aid in critical-size mouse calvarial defect repair. First, we verified the pro-osteogenic effect of SAG in vitro, using primary neonatal mouse calvarial cells (NMCCs). Next, a 4 mm nonhealing defect was created in the mid-parietal bone of 10-week-old CD-1 mice. The scaffold consisted of a custom-fabricated poly(lactic-co-glycolic acid) disc with hydroxyapatite coating (measuring 4 mm diameter × 0.5 mm thickness). Treatment groups included dimethylsulfoxide control (n = 6), 0.5 mM SAG (n = 7) or 1.0 mM SAG (n = 7). Evaluation was performed at 4 and 8 weeks postoperative, by a combination of high-resolution microcomputed tomography, histology (H & E, Masson's Trichrome), histomorphometry, and immunohistochemistry (BSP, OCN, VEGF). In vivo results showed that SAG treatment induced a significant and dose-dependent increase in calvarial bone healing by all radiographic parameters. Histomorphometric analysis showed an increase in all parameters of bone formation with SAG treatment, but also an increase in blood vessel number and density. In summary, SAG is a pro-osteogenic, provasculogenic stimulus when applied locally in a bone defect environment.
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Affiliation(s)
- Soonchul Lee
- 1 Division of Growth and Development and Section of Orthodontics, School of Dentistry, University of California , Los Angeles, Los Angeles, California.,2 Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University , Republic of Korea.,3 Department of Orthopaedic Surgery and the Orthopaedic Hospital Research Center, University of California , Los Angeles, Los Angeles, California
| | - Jia Shen
- 1 Division of Growth and Development and Section of Orthodontics, School of Dentistry, University of California , Los Angeles, Los Angeles, California
| | - Hsin Chuan Pan
- 1 Division of Growth and Development and Section of Orthodontics, School of Dentistry, University of California , Los Angeles, Los Angeles, California
| | - Swati Shrestha
- 3 Department of Orthopaedic Surgery and the Orthopaedic Hospital Research Center, University of California , Los Angeles, Los Angeles, California
| | - Greg Asatrian
- 1 Division of Growth and Development and Section of Orthodontics, School of Dentistry, University of California , Los Angeles, Los Angeles, California
| | - Alan Nguyen
- 1 Division of Growth and Development and Section of Orthodontics, School of Dentistry, University of California , Los Angeles, Los Angeles, California
| | - Carolyn Meyers
- 4 Department of Pathology, Johns Hopkins University , Baltimore, Maryland
| | - Vi Nguyen
- 1 Division of Growth and Development and Section of Orthodontics, School of Dentistry, University of California , Los Angeles, Los Angeles, California
| | - Min Lee
- 5 Section of Biomaterials, School of Dentistry, University of California , Los Angeles, Los Angeles, California
| | - Chia Soo
- 3 Department of Orthopaedic Surgery and the Orthopaedic Hospital Research Center, University of California , Los Angeles, Los Angeles, California.,6 Division of Plastic and Reconstructive Surgery, Department of Surgery, David Geffen School of Medicine, University of California , Los Angeles, Los Angeles, California
| | - Kang Ting
- 2 Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University , Republic of Korea.,3 Department of Orthopaedic Surgery and the Orthopaedic Hospital Research Center, University of California , Los Angeles, Los Angeles, California
| | - Aaron W James
- 3 Department of Orthopaedic Surgery and the Orthopaedic Hospital Research Center, University of California , Los Angeles, Los Angeles, California.,4 Department of Pathology, Johns Hopkins University , Baltimore, Maryland
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15
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Yoon D, Kang BJ, Kim Y, Lee SH, Rhew D, Kim WH, Kweon OK. Effect of serum-derived albumin scaffold and canine adipose tissue-derived mesenchymal stem cells on osteogenesis in canine segmental bone defect model. J Vet Sci 2016; 16:397-404. [PMID: 26119162 PMCID: PMC4701731 DOI: 10.4142/jvs.2015.16.4.397] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 05/08/2015] [Accepted: 06/02/2015] [Indexed: 11/21/2022] Open
Abstract
Composite biological and synthetic grafts with progenitor cells offer an alternative approach to auto- or allografts for fracture repair. This study was conducted to evaluate osteogenesis of autologous serum-derived albumin (ASA) scaffolds seeded with canine adipose tissue-derived mesenchymal stem cells (Ad-MSCs) in a canine segmental bone defect model. ASA scaffold was prepared with canine serum using cross-linking and freeze-drying procedures. Beta-tricalcium phosphate (β-TCP) was mixed at the cross-linking stage. Ad-MSCs were seeded into the scaffold and incubated for one day before implantation. After 16 weeks, the grafts were harvested for histological analysis. The dogs were divided into five groups: control, ASA scaffolds with and without Ad-MSCs, and ASA scaffolds including β-TCP with and without Ad-MSCs. ASA scaffolds with Ad-MSCs had a significantly larger area of increased opacity at the proximal and distal host cortex-implant interfaces in radiographs 16 weeks after implantation compared to the groups with β-TCP (p < 0.05). Histomorphometric analysis showed that ASA scaffolds with Ad-MSCs had significantly greater new bone formation than other groups (p < 0.05). These results suggest that Ad-MSCs seeded into ASA scaffolds enhanced osteogenesis in the bone defect model, but that β-TCP in the ASA scaffold might prevent penetration of the cells required for bone healing.
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Affiliation(s)
- Daeyoung Yoon
- Department of Veterinary Surgery, College of Veterinary Medicine, Seoul National University, Seoul 08826, Korea
| | - Byung-Jae Kang
- Department of Veterinary Surgery, College of Veterinary Medicine, Kangwon National University, Chuncheon 24341, Korea
| | - Yongsun Kim
- Department of Veterinary Surgery, College of Veterinary Medicine, Seoul National University, Seoul 08826, Korea.,BK21 PLUS Program for Creative Veterinary Science Research, Research Institute for Veterinary Science and College of Veterinary Medicine, Seoul National University, Seoul 08826, Korea
| | - Seung Hoon Lee
- Department of Veterinary Surgery, College of Veterinary Medicine, Seoul National University, Seoul 08826, Korea.,BK21 PLUS Program for Creative Veterinary Science Research, Research Institute for Veterinary Science and College of Veterinary Medicine, Seoul National University, Seoul 08826, Korea
| | - Daeun Rhew
- Department of Veterinary Surgery, College of Veterinary Medicine, Seoul National University, Seoul 08826, Korea
| | - Wan Hee Kim
- Department of Veterinary Surgery, College of Veterinary Medicine, Seoul National University, Seoul 08826, Korea
| | - Oh-Kyeong Kweon
- Department of Veterinary Surgery, College of Veterinary Medicine, Seoul National University, Seoul 08826, Korea.,BK21 PLUS Program for Creative Veterinary Science Research, Research Institute for Veterinary Science and College of Veterinary Medicine, Seoul National University, Seoul 08826, Korea
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16
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Bigham-Sadegh A, Oryan A. Selection of animal models for pre-clinical strategies in evaluating the fracture healing, bone graft substitutes and bone tissue regeneration and engineering. Connect Tissue Res 2015; 56:175-94. [PMID: 25803622 DOI: 10.3109/03008207.2015.1027341] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In vitro assays can be useful in determining biological mechanism and optimizing scaffold parameters, however translation of the in vitro results to clinics is generally hard. Animal experimentation is a better approximation than in vitro tests, and usage of animal models is often essential in extrapolating the experimental results and translating the information in a human clinical setting. In addition, usage of animal models to study fracture healing is useful to answer questions related to the most effective method to treat humans. There are several factors that should be considered when selecting an animal model. These include availability of the animal, cost, ease of handling and care, size of the animal, acceptability to society, resistance to surgery, infection and disease, biological properties analogous to humans, bone structure and composition, as well as bone modeling and remodeling characteristics. Animal experiments on bone healing have been conducted on small and large animals, including mice, rats, rabbits, dogs, pigs, goats and sheep. This review also describes the molecular events during various steps of fracture healing and explains different means of fracture healing evaluation including biomechanical, histopathological and radiological assessments.
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Affiliation(s)
- Amin Bigham-Sadegh
- Faculty of Veterinary Medicine, Department of Veterinary Surgery and Radiology, Shahrekord University , Shahrekord , Iran and
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17
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Sheikh Z, Sima C, Glogauer M. Bone Replacement Materials and Techniques Used for Achieving Vertical Alveolar Bone Augmentation. MATERIALS 2015. [PMCID: PMC5455762 DOI: 10.3390/ma8062953] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Alveolar bone augmentation in vertical dimension remains the holy grail of periodontal tissue engineering. Successful dental implant placement for restoration of edentulous sites depends on the quality and quantity of alveolar bone available in all spatial dimensions. There are several surgical techniques used alone or in combination with natural or synthetic graft materials to achieve vertical alveolar bone augmentation. While continuously improving surgical techniques combined with the use of auto- or allografts provide the most predictable clinical outcomes, their success often depends on the status of recipient tissues. The morbidity associated with donor sites for auto-grafts makes these techniques less appealing to both patients and clinicians. New developments in material sciences offer a range of synthetic replacements for natural grafts to address the shortcoming of a second surgical site and relatively high resorption rates. This narrative review focuses on existing techniques, natural tissues and synthetic biomaterials commonly used to achieve vertical bone height gain in order to successfully restore edentulous ridges with implant-supported prostheses.
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Affiliation(s)
- Zeeshan Sheikh
- Matrix Dynamics Group, Faculty of Dentistry, University of Toronto, Room 221, Fitzgerald Building, 150 College Street, Toronto, ON M5S 3E2, Canada; E-Mail:
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-514-224-7490
| | - Corneliu Sima
- Department of Applied Oral Sciences, The Forsyth Institute, 245 First Street, Cambridge, MA 02142, USA; E-Mail:
| | - Michael Glogauer
- Matrix Dynamics Group, Faculty of Dentistry, University of Toronto, Room 221, Fitzgerald Building, 150 College Street, Toronto, ON M5S 3E2, Canada; E-Mail:
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18
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Al Kayal T, Panetta D, Canciani B, Losi P, Tripodi M, Burchielli S, Ottoni P, Salvadori PA, Soldani G. Evaluation of the effect of a gamma irradiated DBM-pluronic F127 composite on bone regeneration in Wistar rat. PLoS One 2015; 10:e0125110. [PMID: 25897753 PMCID: PMC4405568 DOI: 10.1371/journal.pone.0125110] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 03/20/2015] [Indexed: 11/25/2022] Open
Abstract
Demineralized bone matrix (DBM) is widely used for bone regeneration. Since DBM is prepared in powder form its handling properties are not optimal and limit the clinical use of this material. Various synthetic and biological carriers have been used to enhance the DBM handling. In this study we evaluated the effect of gamma irradiation on the physical-chemical properties of Pluronic and on bone morphogenetic proteins (BMPs) amount in DBM samples. In vivo studies were carried out to investigate the effect on bone regeneration of a gamma irradiated DBM-Pluronic F127 (DBM-PF127) composite implanted in the femur of rats. Gamma irradiation effects (25 kGy) on physical-chemical properties of Pluronic F127 were investigated by rheological and infrared analysis. The BMP-2/BMP-7 amount after DBM irradiation was evaluated by ELISA. Bone regeneration capacity of DBM-PF127 containing 40% (w/w) of DBM was investigated in transcortical holes created in the femoral diaphysis of Wistar rat. Bone porosity, repaired bone volume and tissue organization were evaluated at 15, 30 and 90 days by Micro-CT and histological analysis. The results showed that gamma irradiation did not induce significant modification on physical-chemical properties of Pluronic, while a decrease in BMP-2/BMP-7 amount was evidenced in sterilized DBM. Micro-CT and histological evaluation at day 15 post-implantation revealed an interconnected trabeculae network in medullar cavity and cellular infiltration and vascularization of DBM-PF127 residue. In contrast a large rate of not connected trabeculae was observed in Pluronic filled and unfilled defects. At 30 and 90 days the DBM-PF127 samples shown comparable results in term of density and thickness of the new formed tissue respect to unfilled defect. In conclusion a gamma irradiated DBM-PF127 composite, although it may have undergone a significant decrease in the concentration of BMPs, was able to maintains bone regeneration capability.
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Affiliation(s)
- Tamer Al Kayal
- Institute of Clinical Physiology- CNR, Pisa, Italy
- * E-mail:
| | | | - Barbara Canciani
- University & IRCCS AOU San Martino—IST, National Institute for Cancer Research, DIMES, Genova, Italy
| | - Paola Losi
- Institute of Clinical Physiology- CNR, Pisa, Italy
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19
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Naderi N, Ardehali B, Mosahebi A. Biomaterials and structural fat grafting. Plast Reconstr Surg 2015. [DOI: 10.1002/9781118655412.ch3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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20
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Drosos GI, Touzopoulos P, Ververidis A, Tilkeridis K, Kazakos K. Use of demineralized bone matrix in the extremities. World J Orthop 2015; 6:269-277. [PMID: 25793167 PMCID: PMC4363809 DOI: 10.5312/wjo.v6.i2.269] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 07/07/2014] [Accepted: 10/16/2014] [Indexed: 02/06/2023] Open
Abstract
Autologous bone graft is considered as the gold standard for all indications for bone grafting procedures but the limited availability and complications in donor site resulted in seeking other options like allografts and bone graft substitutes. Demineralized bone matrix (DBM) is an allograft product with no quantity limitation. It is an osteoconductive material with osteoinductive capabilities, which vary among different products, depending on donor characteristics and differences in processing of the bone. The purpose of the present review is to provide a critical review of the existing literature concerning the use of DBM products in various procedures in the extremities. Clinical studies describing the use of DBM alone or in combination with other grafting material are available for only a few commercial products. The Level of Evidence of these studies and the resulting Grades of Recommendation are very low. In conclusion, further clinical studies of higher quality are required in order to improve the Recommendation Grades for or against the use of DBM products in bone grafting procedures.
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21
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Comparison of Fusion Rates between Glycerol-Preserved and Frozen Composite Allografts in Cervical Fusion. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:960142. [PMID: 27382618 PMCID: PMC4897249 DOI: 10.1155/2014/960142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 07/31/2014] [Indexed: 11/25/2022]
Abstract
Background. This retrospective, two cohort series study was designed to compare a room temperature, glycerol-preserved composite pinned bone allograft (G-CPBA) with the same graft type provided in a frozen state (F-CPBA) for use as a cervical interbody spacer in anterior cervical discectomy and fusion (ACDF). Methods. A comprehensive chart review was performed for 67 sequential patients that received either a F-CPBA or a G-CPBA and had at least one-year follow-up. Twenty-eight patients had received G-CPBA grafts and 37 patients had received F-CPBA grafts. Two additional 2-level patients had received one of each type of grafts. Results. At 3 months, 45.3% (29 of 64) of glycerol-preserved and 41.4% (29 of 70) of frozen allografts, respectively, were considered to be fused radiographically. At 12 months, 100% of both treatment groups (41 glycerol-preserved and 45 frozen) were considered fused. Fusion rates for G-CPBA were statistically similar to F-CPBA at both 3 and 12 months (P = 0.6535 and >0.999, resp.). There were no allograft related complications in either treatment group. Conclusions. 100% fusion rates were attained by both treatment groups at 12 months and were similar at short-term follow-up for all comparable levels. Level of Evidence. Level of evidence is III.
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22
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Badrinath R, Bohl DD, Hustedt JW, Webb ML, Grauer JN. Only prolonged time from abstraction found to affect viable nucleated cell concentrations in vertebral body bone marrow aspirate. Spine J 2014; 14:990-5. [PMID: 24184640 DOI: 10.1016/j.spinee.2013.10.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 09/05/2013] [Accepted: 10/17/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Vertebral body-derived bone marrow aspirate (BMA, with an appropriate carrier) is a potential alternative to traditional iliac crest bone graft for use in spinal fusion surgery. No studies have looked at the effect of different temporary handling/storage conditions on the osteoprogenitor potential of BMA. This is especially important because aspirate, as with cancellous and/or cortical grafts, may be extracted some time before actual implementation in regular clinical use. PURPOSE To characterize factors that affect BMA cell concentration during routine spinal instrumentation, this study examined whether cell counts change significantly between the second pedicle aspirated and the first pedicle harvested at the same vertebral level. This study also aims to examine the optimal perioperative storage conditions for BMA obtained from the vertebral body. STUDY DESIGN In vitro concentrations of viable cells were determined in BMA harvested from the first and second pedicles on every vertebral level, and after 1 hour of storage in different perioperative conditions. PATIENT SAMPLE BMA was harvested from 28 pedicles from seven patients undergoing lumbar instrumented fusion surgeries. OUTCOME MEASURES The outcome measure included viable nucleated cell concentrations in BMA. METHODS After obtaining HIC approval from our institution, 28 vertebral marrow aspirates (obtained from seven patients) were evaluated. Based on prior work, 4-mL aspirates from each pedicle were evaluated. BMA was aspirated from both pedicles of two vertebral levels per patient. Samples were divided and placed in different storage conditions to examine the effect of laterality (first versus second pedicle aspirated per level), temperature, media, and time, on nucleated cell counts. No funding was received for this study, and the authors disclose no study specific conflicts of interest. RESULTS Cell count was not significantly different between the first or second side aspirated for each vertebral level. Similarly, no significant differences were found for samples after 1 hour of storage at different temperatures (0 °C, room temperature, or 37 °C) or media (none, saline, essential media). Of the conditions examined, time from aspiration was the only variable found to have an impact on nucleated cell counts (p=.003). The viable cell count decreased to less than half by 4 hours. CONCLUSION As vertebral BMA is increasingly considered as a bone grafting option, the field would be remiss not to consider factors that could affect cell viability after abstraction and before implementation. We expected a greater effect of perioperative storage conditions than was observed. Although the variables evaluated might show small effects on cell viability in a larger study, this would not be expected to be significant. In the current study, only prolonged time from abstraction could be shown to have a significant effect on cell viability.
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Affiliation(s)
- Raghav Badrinath
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, PO Box 208071, New Haven, CT 06520-8071, USA
| | - Daniel D Bohl
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, PO Box 208071, New Haven, CT 06520-8071, USA
| | - Joshua W Hustedt
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, PO Box 208071, New Haven, CT 06520-8071, USA
| | - Matthew L Webb
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, PO Box 208071, New Haven, CT 06520-8071, USA
| | - Jonathan N Grauer
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, PO Box 208071, New Haven, CT 06520-8071, USA.
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23
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Sardar Z, Jarzem P. Failure of a carbon fiber-reinforced polymer implant used for transforaminal lumbar interbody fusion. Global Spine J 2013; 3:253-6. [PMID: 24436878 PMCID: PMC3854590 DOI: 10.1055/s-0033-1343075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 01/15/2013] [Indexed: 11/08/2022] Open
Abstract
Lumbar interbody fusion is a common procedure owing to the high prevalence of degenerative spinal disorders. During such procedures, carbon fiber-reinforced polymer (CFRP) cages are frequently utilized to fill the void created between adjacent vertebral bodies, to provide mechanical stability, and to carry graft material. Failure of such implants can lead to significant morbidity. We discuss the possible causes leading to the failure of a CFRP cage in a patient with rheumatoid arthritis. Review of a 49-year-old woman who underwent revision anterior lumbar interbody fusion 2 years after posterior instrumentation and transforaminal lumbar interbody fusion at L4-L5 and L5-S1. The patient developed pseudarthrosis at the two previously fused levels with failure of the posterior instrumentation. Revision surgery reveled failure with fragmentation of the CFRP cage at the L5-S1 level. CFRP implants can break if mechanical instability or nonunion occurs in the spinal segments, thus emphasizing the need for optimizing medical management and meticulous surgical technique in achieving stability.
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Affiliation(s)
- Zeeshan Sardar
- McGill University Health Centre, Montreal, Quebec, Canada,Address for correspondence Zeeshan Sardar, MDCM, MSc Orthopaedic Residency Training Program, Shriners Hospital for Children1529 Cedar Avenue, Montreal, QuebecCanada H3G 1A6
| | - Peter Jarzem
- McGill University Health Centre, Montreal, Quebec, Canada
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24
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Mathavan N, Bosemark P, Isaksson H, Tägil M. Investigating the synergistic efficacy of BMP-7 and zoledronate on bone allografts using an open rat osteotomy model. Bone 2013; 56:440-8. [PMID: 23845325 DOI: 10.1016/j.bone.2013.06.030] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 06/18/2013] [Accepted: 06/25/2013] [Indexed: 02/04/2023]
Abstract
Bone grafts are well-established in the treatment of fracture non-unions but union is still not always achieved. Harvesting autograft is associated with donor site morbidity and the available amount of bone is limited. Allograft is more easily obtained and available in greater quantities but lacks the osteoinductive characteristics of autograft. We have previously shown a synergistic effect of bone morphogenetic protein (BMP-7), systemic bisphosphonates and autograft. In the present study we hypothesized that the combination of allograft+BMP-7+systemic ZA is more effective than autograft alone, which is currently the most frequently used aid in augmenting fracture and non-union healing. Femoral osteotomies were performed on 82 male Sprague Dawley rats and fixed with intramedullary K-wires. The rats were randomized into 7 groups: (i) saline, (ii) autograft, (iii) allograft, (iv) allograft+BMP-7, (v) autograft+zoledronate (ZA), (vi) allograft+ZA and (vii) allograft+BMP-7+ZA. Autografts were harvested from the contralateral tibia. Allografts were obtained from donor rats and frozen. BMP-7 was administered locally in the form of a putty placed circumferentially around the osteotomy. At 2 weeks, the rats were injected with a single dose of either saline or ZA. The rats were sacrificed at 6 weeks and the femurs were evaluated using radiography, histology, μCT and three-point bending tests. Complete radiological healing was seen in all rats in the BMP-7 groups. The callus volume was larger and the calluses were denser with allograft+BMP-7+ZA than in all other groups (μCT, p<0.001). Mechanical testing yielded a substantially higher peak force with the allograft+BMP-7+ZA combination than all other groups (p<0.01, p<0.001). This was further reinforced in the 59% increase in the peak force observed in the osteotomized femurs of the allograft+BMP-7+ZA group compared to the control femurs (p<0.01), whereas significant decreases of 22-27% were observed in the saline or bone-graft alone groups (p<0.01, p<0.05). Thus our results suggest that allograft combined with the anabolic effect of BMP-7 and the anti-catabolic effect of zoledronate is more efficient than autograft alone.
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Abstract
Replacement of missing bone stock is a reconstructive challenge to upper extremity surgeons and decision-making with regards to available choices remains difficult. Preference is often given to autograft in the form of cancellous, cortical, or corticocancellous grafts from donor sites. However, the available volume from such donor sites is limited and fraught with potential complications. Advances in surgical management and medical research have produced a wide array of potential substances that can be used for bone graft substitute. Considerations in selecting bone grafts and substitutes include characteristic capabilities, availability, patient morbidity, immunogenicity, potential disease transmission, and cost variability.
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Affiliation(s)
- Reena A Bhatt
- Department of Plastic Surgery, Warren Alpert Medical School of Brown University, The Miriam and Rhode Island Hospitals, 235 Plain Street, Providence, RI 02903, USA
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26
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Guerado E, Andrist T, Andrades J, Santos L, Cerván A, Guerado G, Becerra J. Spinal arthrodesis. Basic science. Rev Esp Cir Ortop Traumatol (Engl Ed) 2012. [DOI: 10.1016/j.recote.2012.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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27
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Guerado E, Andrist T, Andrades JA, Santos L, Cerván A, Guerado G, Becerra J. [Spinal arthrodesis. basic science]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2012; 56:227-44. [PMID: 23594811 DOI: 10.1016/j.recot.2012.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 01/19/2012] [Indexed: 01/01/2023] Open
Abstract
Spinal arthrodesis consists of a combination of a system of mechanical stabilisation of one or more vertebral segments with a biological substance that promotes osteoneogenesis, with aim of achieving the permanent fusion between areas more or less the same size of these segments. In spinal arthrodesis, the biological support par excellence is the autograft. However, obtaining this involves a high incidence of morbidity and, in cases of arthrodesis of more than one intervertebral space, the quantity available is usually insufficient. The extraction and implantation time prolongs the surgery, increasing the exposure to and risk of bleeding and infection. For these reasons, there is a search for substances that possess the properties of the autograft, avoiding the morbidity and added surgical time required to extract the autograft. The biomechanical-biological interaction in vertebral arthrodesis has been studied in this article.
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Affiliation(s)
- E Guerado
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Costa del Sol, Universidad de Málaga, Marbella, Málaga, España.
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Zermatten P, Wettstein M. Iliac wing fracture following graft harvesting from the anterior iliac crest: literature review based on a case report. Orthop Traumatol Surg Res 2012; 98:114-7. [PMID: 22130003 DOI: 10.1016/j.otsr.2011.03.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2010] [Revised: 02/21/2011] [Accepted: 03/21/2011] [Indexed: 02/02/2023]
Abstract
The morbidity of bone graft harvesting from the iliac crest has been widely discussed in the literature. For some authors, it is considered to be low and for others relatively high. We report on a case of a fracture of the iliac wing after graft harvesting from the anterior iliac crest despite good surgical technique. This complication is well known and most of these fractures heal uneventfully if treated conservatively. However, if anatomical and technical considerations are respected, the patient could be spared this inconvenience. Based on a literature review, we discuss the procedure's potential complications and how to avoid them in an update.
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Affiliation(s)
- P Zermatten
- Department of Musculoskeletal Medicine, University of Lausanne, Lausanne, Switzerland.
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Nanostructured biomaterials for tissue engineered bone tissue reconstruction. Int J Mol Sci 2012; 13:737-757. [PMID: 22312283 PMCID: PMC3269717 DOI: 10.3390/ijms13010737] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 12/30/2011] [Accepted: 12/31/2011] [Indexed: 11/28/2022] Open
Abstract
Bone tissue engineering strategies are emerging as attractive alternatives to autografts and allografts in bone tissue reconstruction, in particular thanks to their association with nanotechnologies. Nanostructured biomaterials, indeed, mimic the extracellular matrix (ECM) of the natural bone, creating an artificial microenvironment that promotes cell adhesion, proliferation and differentiation. At the same time, the possibility to easily isolate mesenchymal stem cells (MSCs) from different adult tissues together with their multi-lineage differentiation potential makes them an interesting tool in the field of bone tissue engineering. This review gives an overview of the most promising nanostructured biomaterials, used alone or in combination with MSCs, which could in future be employed as bone substitutes. Recent works indicate that composite scaffolds made of ceramics/metals or ceramics/polymers are undoubtedly more effective than the single counterparts in terms of osteoconductivity, osteogenicity and osteoinductivity. A better understanding of the interactions between MSCs and nanostructured biomaterials will surely contribute to the progress of bone tissue engineering.
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Salari B, McAfee PC. Cervical total disk replacement: complications and avoidance. Orthop Clin North Am 2012; 43:97-107, ix. [PMID: 22082633 DOI: 10.1016/j.ocl.2011.08.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Anterior cervical diskectomy and fusion for neurologic deficits, radicular arm pain, and neck pain refractory to conservative management are successful. The approach and procedure were first described in 1955 and have become the anterior cervical standard of care for orthopedic surgeons and neurosurgeons. Advancements and innovations have addressed disease processes of the cervical spine with motion-preserving technology. The possibility of obtaining anterior cervical decompression while maintaining adjacent segment motion led to the advent of cervical total disk replacement. The Food and Drug Administration has approved 3 cervical devices with other investigational device exemption trials under way.
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Affiliation(s)
- Behnam Salari
- The Spine and Scoliosis Center, St. Joseph's Hospital, 7505 Osler Drive, Towson, MD 21204, USA
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Abstract
Autogenous cancellous bone graft provides an osteoconductive, osteoinductive, and osteogenic substrate for filling bone voids and augmenting fracture-healing.The iliac crest remains the most frequently used site for bone-graft harvest, but the proximal part of the tibia, distal end of the radius, distal aspect of the tibia, and greater trochanter are alternative donor sites that are particularly useful for bone-grafting in the ipsilateral extremity.The most common complication associated with the harvest of autogenous bone graft is pain at the donor site, with less frequent complications including nerve injury, hematoma, infection, and fracture at the donor site.Induced membranes is a method that uses a temporary polymethylmethacrylate cement spacer to create a bone-graft-friendly environment to facilitate graft incorporation, even in large segmental defects.
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Affiliation(s)
- Chad Myeroff
- Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Minneapolis, MN 55454, USA.
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Miron RJ, Hedbom E, Saulacic N, Zhang Y, Sculean A, Bosshardt DD, Buser D. Osteogenic potential of autogenous bone grafts harvested with four different surgical techniques. J Dent Res 2011; 90:1428-33. [PMID: 21940523 DOI: 10.1177/0022034511422718] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The osteogenic potential of autogenous bone grafts is superior to that of allografts and xenografts because of their ability to release osteoinductive growth factors and provide a natural osteoconductive surface for cell attachment and growth. In this in vitro study, autogenous bone particles were harvested by four commonly used techniques and compared for their ability to promote an osteogenic response. Primary osteoblasts were isolated and seeded on autogenous bone grafts prepared from the mandibles of miniature pigs with a bone mill, piezo-surgery, bone scraper, and bone drill (bone slurry). The osteoblast cultures were compared for their ability to promote cell attachment, proliferation, and differentiation. After 4 and 8 hrs, significantly higher cell numbers were associated with bone mill and bone scraper samples compared with those acquired by bone slurry and piezo-surgery. Similar patterns were consistently observed up to 5 days. Furthermore, osteoblasts seeded on bone mill and scraper samples expressed significantly elevated mRNA levels of collagen, osteocalcin, and osterix at 3 and 14 days and produced more mineralized tissue as assessed by alizarin red staining. These results suggest that the larger bone graft particles produced by bone mill and bone scraper techniques have a higher osteogenic potential than bone slurry and piezo-surgery.
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Affiliation(s)
- R J Miron
- Department of Periodontology, Bern University Hospital, Inselspital, Bern, Switzerland
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Ettl T, Gosau M, Sader R, Reichert TE. Jaw cysts - filling or no filling after enucleation? A review. J Craniomaxillofac Surg 2011; 40:485-93. [PMID: 21890372 DOI: 10.1016/j.jcms.2011.07.023] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 07/23/2011] [Accepted: 07/23/2011] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Jaw cysts are common lesions in the oral and maxillofacial region. Enucleation of the lesions and primary closure of the defects, the so-called "cystectomy", has evolved as the treatment of choice. In order to reduce infections and to accelerate bone regeneration, different types of bone grafts are increasingly investigated for defect filling. MATERIAL AND METHODS The present review reflects the most recent studies using autogenous, allogenic, xenogenic and alloplastic bone grafts and compares the results to current investigations about conservative cyst enucleation without using any filling materials. Relevant studies with significant patient sample sizes were electronically searched in PubMed and Medline. RESULTS Simple cyst enucleation and blood clot healing show low complication rates and sufficient bone regeneration even in large defects. Prospective randomized trials comparing the additional use of filling materials to the "cystectomy" are rare. Currently available data do not indicate the superiority of additional bone grafts. CONCLUSION Enucleation of jaw cysts and primary closure without bone substitutes remains "state of the art" in most cases.
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Affiliation(s)
- Tobias Ettl
- Department of Oral and Maxillofacial Surgery, University of Regensburg, Germany.
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Abstract
The use of artificial bone grafts has been developed over recent years and is expected to increase further, for some indications even replacing the gold standard, autograft, in trauma and reconstructive surgery. However, the effectiveness of these materials is still a subject of debate, mostly because of unclear definitions or limited market surveillance. In this overview several facts and myths regarding bone-graft substitutes are summarized.
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Affiliation(s)
- T J Blokhuis
- University Medical Centre Utrecht, Heidelberglaan 100, PO Box 85500, Utrecht, The Netherlands.
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Park BH, Song KJ, Yoon SJ, Park HS, Jang KY, Zhou L, Lee SY, Lee KB, Kim JR. Acceleration of spinal fusion using COMP-angiopoietin 1 with allografting in a rat model. Bone 2011; 49:447-54. [PMID: 21658484 DOI: 10.1016/j.bone.2011.05.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 05/12/2011] [Accepted: 05/22/2011] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Allografting has become widely available for the elimination of morbidity due to autogenous bone grafting procedures for spinal fusion. Enhancement of stable bone formation could facilitate this procedure. COMP-Ang1 is a recombinant chimeric protein of angiopoietin-1 that induces angiogenesis and vascular enlargement. We investigated the osteogenic potential of COMP-Ang1 for spinal fusion with allograft based on the enhancement of angiogenesis. METHODS Sixty Sprague-Dawley rats underwent bilateral posterior and posterolateral arthrodesis with allograft at L3-4 and L4-5. The animals were divided into three groups (n=20 each): (1) no treatment (sham group); (2) the bovine serum albumin-impregnated collagen sponge group (BSA group); 3) the COMP-Ang1-impregnated collagen sponge group (COMP-Ang1 group). Animals were sacrificed at six weeks for evaluation of spinal fusion using manual palpation, radiographs, and biomechanical and histomorphometric assessments. Total RNA was prepared from the fusion site and analyzed for osteogenic marker protein expression using RT-PCR analysis. RESULTS The fusion rates determined by manual palpation were 38.9% in the sham group, 42.1% in the BSA group, and 89.5% in the COMP-Ang1 group. Optical density of fusion masses in the COMP-Ang1 group was significantly higher than those in the sham and BSA groups (p<0.001). Total bone volume was significantly higher in the COMP-Ang1 group than in the sham and BSA groups (p<0.001). The mechanical strength was significantly greater in the COMP-Ang1 group than in the sham and BSA groups (p<0.01). Histologically, the fusion site of the COMP-Ang1 group showed a larger number of reactive bones compared with those in the BSA and sham groups. Immunostaining of endothelial cells for factor VIII revealed that COMP-Ang1 group showed higher levels of vascularity in the fusion site. Runt-related transcription factor 2 and its target genes were significantly up-regulated in the COMP-Ang1 group. CONCLUSIONS COMP-Ang1 induced radiologically and histologically demonstrable active osteogenesis by promoting angiogenesis in spinal fusions. It was concluded that COMP-Ang1 enhances spinal fusion and hence the strength of the fusion.
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Affiliation(s)
- Byung-Hyun Park
- Department of Biochemistry, Medical School and Research Institute for Endocrine Sciences, Chonbuk National University, Jeonju, Jeonbuk, 561-756, Republic of Korea
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Abstract
Surgical treatment of spinal fractures consists of postural reduction and segmental arthrodesis, together with an eventual performance of spinal canal decompression. Spinal arthrodesis consists of the combination of a hardware system for mechanical stabilisation together with a biological substance for enhancement of bone formation. To date, autologous graft is the only biological substance demonstrated to possess osteogenic properties. Cancellous bone graft has greater cellular activity than cortical graft, whereas cortical graft is stronger. Consequently, according to biological and biomechanical properties of autograft, spinal posterior arthrodesis is better enhanced by cancellous autograft, whereas anterior interbody tricortical bone is more suitable for anterior fusion. Allograft does not cause harvesting complications as autograft does, and also its amount is theoretically unlimited; nevertheless the rate of bone fusion facilitated by allograft is far from that enhanced by autograft given that allograft has no osteoprogenitor cells. There is little evidence on the efficacy of demineralised bone matrix for spinal fusion. Bone morphogenetic proteins (BMPs) are in use in spinal surgery, but their exact role with respect to type, dose, and carrier, together with their cost-effectiveness, need further clinical delineation. Calcium phosphate compounds appear to be good as carriers; however, they have no osteoinductive or osteogenic properties. Current clinical literature seem to indicate their usefulness for bony fusion in spinal surgery, when combined with bone marrow aspirate or used as an extender for autologous bone graft. Age, length of fusion, location, and concurrent diseases should be definitive for fusion outcome; papers on spinal arthrodesis should neatly stratify these variables. Unfortunately, since that is not the rule, conclusions drawn from current literature are very unreliable. Autograft remains the gold standard, and cancellous bone is advisable in posterolateral approaches, whereas tricortical iliac crest autograft appears appropriate for interbody support. In longer segments, its expansion with BMPs looks safe at least. Basic knowledge has been achieved from animal experiments, and clinical application of the findings to humans should be done very cautiously; in any case, both anterior and posterior arthrodesis must be protected with instrumentation used according to appropriate biomechanical principles. A combination of failure of the correct graft together with proper instrumentation will result in poorer outcome, even if the right graft is used.
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Kadow-Romacker A, Greiner S, Schmidmaier G, Wildemann B. Effect of β-tricalcium phosphate coated with zoledronic acid on human osteoblasts and human osteoclasts in vitro. J Biomater Appl 2011; 27:577-85. [DOI: 10.1177/0885328211415722] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The combination of a bone graft material with bisphosphonates (BPs) might be advantageous for an optimal balance of material resorption and stimulation of bone formation. This study investigated the effect of β-tricalcium phosphate (β-TCP) bone grafts coated with zoledronic acid (ZOL) on osteoblast-like cells and osteoclast-like cells (OLC). As a drug carrier, the polymer poly(D,L-lactide) was used and three different concentrations of ZOL were tested. β-TCP coated with ZOL stimulated the production of osteocalcin (OC), osteoprotegerin, and sRANKL in osteoblast-like cells. The polymer coating alone caused a significant increase in collagen type 1 and OC production. OLC viability was inhibited and the tartrate-resistant acidic phosphatase isoform-5b was significantly decreased after cultivation on polymer-coated β-TCP for 12 days. The three different concentrations of ZOL decreased cell viability and no TRAPiso-5b was detectable, indicating a strong reduction of the TRAPiso-5b after 12 days in culture. After 21 days in culture, only the higher ZOL concentrations significantly reduced cell viability and TRAPiso-5b. The results of this study show that coating of β-TCP with ZOL has stimulating effects on osteoblast-like cells. Additionally, an inhibition of osteoclasts was seen. The combination of this bone grafting material with BPs might, therefore, be effective in the treatment of large bone defects.
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Affiliation(s)
- A Kadow-Romacker
- Berlin–Brandenburg Center for Regenerative Therapies, Julius Wolff Institut, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - S Greiner
- Center for Musculoskeletal Surgery, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - G Schmidmaier
- Department for Orthopedic and Trauma Surgery, University Clinic of Heidelberg, Heidelberg, Germany
| | - B Wildemann
- Berlin–Brandenburg Center for Regenerative Therapies, Julius Wolff Institut, Charité – Universitätsmedizin Berlin, Berlin, Germany
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38
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Low-intensity pulsed ultrasound enhances posterior spinal fusion implanted with mesenchymal stem cells-calcium phosphate composite without bone grafting. Spine (Phila Pa 1976) 2011; 36:1010-6. [PMID: 21325987 DOI: 10.1097/brs.0b013e318205c5f5] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Experimental study on the effect of low-intensity pulsed ultrasound (LIPUS) on rabbit spinal fusion with mesenchymal stem cell (MSC)-derived osteogenic cells and bioceramic composite. OBJECTIVE To investigate the efficacy of LIPUS in enhancing fusion rate and bone formation with porous tricalcium phosphate (TCP) bioceramic scaffold impregnated with MSCs without any bone grafts. SUMMARY OF BACKGROUND DATA The goal of spinal fusion in the corrective spinal surgery for spinal deformities is to achieve solid bony fusion between selected vertebral segments. Previous studies with bone morphogenetic proteins and genetically manipulated materials revealed significant difficulties in actual clinical application. Alternative such as LIPUS has been shown to be effective in enhancing healing of fracture and nonunion clinically. Its potential for enhancing spinal fusion warrants further in-depth study. METHODS Posterolateral intertransverse processes spinal fusion at the L5 and L6 levels were evaluated in New Zealand white rabbit model. The animals were divided into three groups with (A) TCP alone, (B) TCP with differentiated MSCs, and (C) TCP with differentiated MSCs and LIPUS treatment. At week 7 postoperation, manual palpation, peripheral quantitative computed tomography, and histomorphometric assessments were performed. RESULTS At week 7 postoperation, a statistically significant increase in clinical fusion by manual palpation was observed in group C animals treated with LIPUS (86%) in comparing with groups A (0%) and B (14%) without LIPUS. With peripheral quantitative computed tomographic analysis, the bone volume of group C fusion mass was significantly larger than the other two groups. Group C fusion also had better osteointegration length between host bone and implanted composite and more new bone formed in the TCP implants. Importantly, all the group C animals had osteochondral bridging--early stage of bony fusion histologically. Endochondral ossification was observed at the junction between the cartilaginous and osseous tissues at the intertransverse processes area. Quantitative analysis showed that the fusion mass in group C had significantly smaller gap and larger area of cartilaginous tissue between the transverse processes. CONCLUSION The present study showed that the combination of synthetic biomaterials, autologous differentiated MSCs, and LIPUS could promote clinical fusion in rabbit posterior spinal fusion model. The mechanism was likely to be mediated through better osteointegration between the host bone and implanted materials and enhanced endochondral ossification at the fusion site.
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Mobbs RJ, Sivabalan P, Li J. Technique, challenges and indications for percutaneous pedicle screw fixation. J Clin Neurosci 2011; 18:741-9. [PMID: 21514165 DOI: 10.1016/j.jocn.2010.09.019] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 09/20/2010] [Accepted: 09/22/2010] [Indexed: 01/27/2023]
Abstract
Minimally invasive techniques in spinal surgery are increasing in popularity due to numerous potential advantages, including reduced length of stay, blood loss and requirements for post-operative analgesia as well as earlier return to work. This review discusses guidelines for safe implantation of percutaneous pedicle screws using an image intensifier technique. As indications for percutaneous pedicle screw techniques expand, the nuances of the minimally invasive surgery technique will also expand. It is paramount that experienced surgeons share their collective knowledge to assist surgeons at their early attempts of these complex, and potentially dangerous, procedures. Technical challenges of percutaneous pedicle screw fixation techniques are also discussed including: small pedicle cannulation, percutaneous rod insertion for multilevel constructs, incision selection for multilevel constructs, changing direction with percutaneous pedicle screw placement, L5/S1 screw head proximity and sclerotic pedicles with difficult Jamshidi placement. We discuss potential indications for minimally invasive fusion techniques for complex spinal surgery and support these with descriptions of illustrative patients.
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Affiliation(s)
- Ralph J Mobbs
- Department of Neurosurgery, Prince of Wales Private Hospital, Sydney Spine Clinic, Randwick, New South Wales 2031, Australia.
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Siu RK, Lu SS, Li W, Whang J, McNeill G, Zhang X, Wu BM, Turner AS, Seim HB, Hoang P, Wang JC, Gertzman AA, Ting K, Soo C. Nell-1 protein promotes bone formation in a sheep spinal fusion model. Tissue Eng Part A 2011; 17:1123-35. [PMID: 21128865 PMCID: PMC3063712 DOI: 10.1089/ten.tea.2010.0486] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 12/03/2010] [Indexed: 11/12/2022] Open
Abstract
Bone morphogenetic proteins (BMPs) are widely used as bone graft substitutes in spinal fusion, but are associated with numerous adverse effects. The growth factor Nel-like molecule-1 (Nell-1) is mechanistically distinct from BMPs and can minimize complications associated with BMP therapies. This study evaluates the efficacy of Nell-1 combined with demineralized bone matrix (DBM) as a novel bone graft material for interbody spine fusion using sheep, a phylogenetically advanced animal with biomechanical similarities to human spine. Nell-1+sheep DBM or Nell-1+heat-inactivated DBM (inDBM) (to determine the osteogenic effect of residual growth factors in DBM) were implanted in surgical sites as follows: (1) DBM only (control) (n=8); (2) DBM+0.3 mg/mL Nell-1 (n=8); (3) DBM+0.6 mg/mL Nell-1 (n=8); (4) inDBM only (control) (n=4); (5) inDBM+0.3 mg/mL Nell-1 (n=4); (6) inDBM+0.6 mg/mL Nell-1 (n=4). Fusion was assessed by computed tomography, microcomputed tomography, and histology. One hundred percent fusion was achieved by 3 months in the DBM+0.6 mg/mL Nell-1 group and by 4 months in the inDBM+0.6 mg/mL Nell-1 group; bone volume and mineral density were increased by 58% and 47%, respectively. These fusion rates are comparable to published reports on BMP-2 or autograft bone efficacy in sheep. Nell-1 is an independently potent osteogenic molecule that is efficacious and easily applied when combined with DBM.
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Affiliation(s)
- Ronald K. Siu
- Dental and Craniofacial Research Institute, University of California, Los Angeles, California
- Department of Bioengineering, School of Medicine, University of California, Los Angeles, California
| | - Steven S. Lu
- Dental and Craniofacial Research Institute, University of California, Los Angeles, California
- Department of Neonatology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Weiming Li
- Dental and Craniofacial Research Institute, University of California, Los Angeles, California
- Department of Orthopaedics, First Clinical Hospital, Harbin Medical University, Harbin, China
| | - Julie Whang
- Dental and Craniofacial Research Institute, University of California, Los Angeles, California
- Section of Orthodontics, School of Dentistry, University of California, Los Angeles, California
| | - Gabriel McNeill
- Group in Biostatistics, University of California, Berkeley, California
| | - Xinli Zhang
- Dental and Craniofacial Research Institute, University of California, Los Angeles, California
| | - Benjamin M. Wu
- Dental and Craniofacial Research Institute, University of California, Los Angeles, California
- Department of Bioengineering, School of Medicine, University of California, Los Angeles, California
| | - A. Simon Turner
- Department of Veterinary Sciences, Colorado State University, Fort Collins, Colorado
| | - Howard B. Seim
- Department of Veterinary Sciences, Colorado State University, Fort Collins, Colorado
| | - Paul Hoang
- Section of Orthodontics, School of Dentistry, University of California, Los Angeles, California
| | - Jeffrey C. Wang
- Department of Orthopaedic Surgery, School of Medicine, University of California, Los Angeles, California
| | | | - Kang Ting
- Dental and Craniofacial Research Institute, University of California, Los Angeles, California
- Section of Orthodontics, School of Dentistry, University of California, Los Angeles, California
| | - Chia Soo
- Department of Orthopaedic Surgery, School of Medicine, University of California, Los Angeles, California
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Park SH, Tofighi A, Wang X, Strunk M, Ricketts T, Chang J, Kaplan DL. Calcium phosphate combination biomaterials as human mesenchymal stem cell delivery vehicles for bone repair. J Biomed Mater Res B Appl Biomater 2011; 97:235-44. [PMID: 21384543 DOI: 10.1002/jbm.b.31805] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 10/30/2010] [Accepted: 11/22/2010] [Indexed: 11/09/2022]
Abstract
A new class of biomimetic, bioresorbable apatitic calcium phosphate cement (CPC) was recently developed. The handling characteristics, and the ability to harden at body temperature in the presence of physiological saline, make this material an attractive clinical bone substitute and delivery vehicle for therapeutic agents in orthopedic applications. The major challenge with the material is formulating an injectable paste with options for cell delivery, in order to regenerate new bone faster and with high quality. In this study, three different additives and/or viscosity modifiers (carboxymethylcellulose, silk, and alginate) were incorporated into a CPC matrix. Injectability, cell viability, cell proliferation, surface morphology, and gene expression for osteogenesis of hMSCs were all evaluated. Injectable CPC-gel composites with cell protection were achieved. The CPC modified with alginate provided the best results based on cell proliferation, ALP and collagen production, and osteogenic transcript increases (for ALP, type I collagen, BSP, and OP). Furthermore, osteogenic analysis indicated lineage-specific differentiation of hMSCs into osteogenic outcomes. The results suggest that CPC mixed with alginate can be used as a cell delivery vehicle for bone regeneration.
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Affiliation(s)
- Sang-Hyug Park
- ETEX Corporation, University Park at MIT, Cambridge, Massachusetts 02139, USA
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[Radiological comparison between two procedures for ventral spondylodesis: autologous iliac crest bone graft vs bovine bone graft]. Unfallchirurg 2011; 115:897-902. [PMID: 21331816 DOI: 10.1007/s00113-010-1945-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The objective of this study was the radiological evaluation of osseous integration of autologous iliac crest graft and bovine bone graft after spondylodesis based on a standardized score. MATERIAL AND METHODS Spondylodesis was performed on 18 sheep, divided into 2 groups, 1 with an autologous iliac crest graft and the other with a bovine bone graft. Computed tomography was performed 12 and 24 weeks postoperatively. The osseous integration was assessed by the Tübinger Score. RESULTS The evaluation of the CT scans demonstrated a significantly better osseous integration of the autologous iliac crest graft compared to the bovine bone graft. CONCLUSIONS Based on our results, the bovine bone graft as a transplant for spondylodesis is inadvisable.
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The ultrasound-guided transversus abdominis plane block for anterior iliac crest bone graft postoperative pain relief: a prospective descriptive study. Reg Anesth Pain Med 2011; 35:520-4. [PMID: 20975466 DOI: 10.1097/aap.0b013e3181fa117a] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acute postoperative pain and nerve injuries frequently lead to neuropathic chronic pain after anterior iliac crest (AIC) bone graft. This prospective study evaluated postoperative pain relief after preoperative ultrasound-guided transversus abdominis plane (TAP) block for orthopedic surgery with an AIC bone harvest and the prevalence of pain chronicization at 18 months after surgery. METHODS Thirty-three consecutive patients scheduled for major orthopedic surgery with an AIC harvest for autologous bone graft were studied. Preoperative TAP blocks were performed under in-plane needle ultrasound guidance, anterior to the midaxillary line (15 mL ropivacaine 0.33%). The extent of sensory blockade was evaluated at 20 mins with cold and light-touch tests. Pain at the iliac crest graft site was assessed at rest by visual analog scale (VAS) scores in the postanesthetic care unit, and at 1, 6, 12, 24, and 48 hrs after surgery. Time for first request of morphine and total morphine consumption were recorded. Eighteen months after surgery, each patient was interviewed by phone about the importance and localization of pain chronicization. RESULTS Median VAS score was 0 (range, 0-7) at all periods of assessment. At 20 mins, 62.5% of the patients reported complete anesthesia, and 34% hypoesthesia. The sensory blockade extent ranged from T9 (T7-T11) to L1 (T11-L2) in median (range) values. At 18 months, 80% of patients did not complain about pain or discomfort at the iliac crest site; 20% reported pain chronicization at the iliac crest site (VAS scores 2-4). Five patients (26%) complained about numbness at the iliac crest area. CONCLUSIONS Ultrasound-guided TAP block is an appropriate technique for postoperative analgesia after AIC bone harvest in orthopedic surgery.
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Van Lieshout EMM, Van Kralingen GH, El-Massoudi Y, Weinans H, Patka P. Microstructure and biomechanical characteristics of bone substitutes for trauma and orthopaedic surgery. BMC Musculoskelet Disord 2011; 12:34. [PMID: 21288333 PMCID: PMC3040718 DOI: 10.1186/1471-2474-12-34] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Accepted: 02/02/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many (artificial) bone substitute materials are currently available for use in orthopaedic trauma surgery. Objective data on their biological and biomechanical characteristics, which determine their clinical application, is mostly lacking. The aim of this study was to investigate structural and in vitro mechanical properties of nine bone substitute cements registered for use in orthopaedic trauma surgery in the Netherlands. METHODS Seven calcium phosphate cements (BoneSource®, Calcibon®, ChronOS®, Eurobone®, HydroSet™, Norian SRS®, and Ostim®), one calcium sulphate cement (MIIG® X3), and one bioactive glass cement (Cortoss®) were tested. Structural characteristics were measured by micro-CT scanning. Compression strength and stiffness were determined following unconfined compression tests. RESULTS Each bone substitute had unique characteristics. Mean total porosity ranged from 53% (Ostim®) to 0.5% (Norian SRS®). Mean pore size exceeded 100 μm only in Eurobone® and Cortoss® (162.2 ± 107.1 μm and 148.4 ± 70.6 μm, respectively). However, 230 μm pores were found in Calcibon®, Norian SRS®, HydroSet™, and MIIG® X3. Connectivity density ranged from 27/cm3 for HydroSet™ to 0.03/cm3 for Calcibon®. The ultimate compression strength was highest in Cortoss® (47.32 MPa) and lowest in Ostim® (0.24 MPa). Young's Modulus was highest in Calcibon® (790 MPa) and lowest in Ostim® (6 MPa). CONCLUSIONS The bone substitutes tested display a wide range in structural properties and compression strength, indicating that they will be suitable for different clinical indications. The data outlined here will help surgeons to select the most suitable products currently available for specific clinical indications.
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Affiliation(s)
- Esther M M Van Lieshout
- Department of Surgery-Traumatology, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
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Van der Stok J, Van Lieshout EM, El-Massoudi Y, Van Kralingen GH, Patka P. Bone substitutes in the Netherlands - a systematic literature review. Acta Biomater 2011; 7:739-50. [PMID: 20688196 DOI: 10.1016/j.actbio.2010.07.035] [Citation(s) in RCA: 145] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Revised: 07/26/2010] [Accepted: 07/28/2010] [Indexed: 01/28/2023]
Abstract
Autologous bone grafting is currently considered as the gold standard to restore bone defects. However, clinical benefit is not guaranteed and there is an associated 8-39% complication rate. This has resulted in the development of alternative (synthetic) bone substitutes. The aim of this systematic literature review was to provide a comprehensive overview of literature data of bone substitutes registered in the Netherlands for use in trauma and orthopedic surgery. Brand names of selected products were used as search terms in three available databases: Embase, PubMed and Cochrane. Manuscripts written in English, German or Dutch that reported on structural, biological or biomechanical properties of the pure product or on its use in trauma and orthopedic surgery were included. The primary search resulted in 475 manuscripts from PubMed, 653 from Embase and 10 from Cochrane. Of these, 218 met the final inclusion criteria. Of each product, structural, biological and biomechanical characteristics as well as their clinical indications in trauma and orthopedic surgery are provided. All included products possess osteoconductive properties but differ in resorption time and biomechanical properties. They have been used for a wide range of clinical applications; however, the overall level of clinical evidence is low. The requirements of an optimal bone substitute are related to the size and location of the defect. Calcium phosphate grafts have been used for most trauma and orthopedic surgery procedures. Calcium sulphates were mainly used to restore bone defects after tumour resection surgery but offer minimal structural support. Bioactive glass remains a potential alternative; however, its use has only been studied to a limited extent.
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Vaz K, Verma K, Protopsaltis T, Schwab F, Lonner B, Errico T. Bone grafting options for lumbar spine surgery: a review examining clinical efficacy and complications. SAS JOURNAL 2010; 4:75-86. [PMID: 25802654 PMCID: PMC4365636 DOI: 10.1016/j.esas.2010.01.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Iliac crest harvest has been considered the “gold standard” at producing successful arthrodesis of the lumbar spine but is also associated with many donor-site morbidities. Many alternatives have been used to avoid iliac crest harvest, including autologous bone from other donor sites, allogeneic bone, ceramics, and recombinant human bone morphogenetic proteins (rhBMPs). This review will highlight the properties and preparations of these graft types and their potential complications and reported clinical efficacy. Methods A Medline search was conducted via PubMed by use of the following terms in various combinations: lumbar fusion, freeze-dried allograft, fresh-frozen allograft, autograft, iliac crest, demineralized bone matrix, rhBMP-2, rhBMP-7, scoliosis, bone marrow aspirate, HEALOS, coralline hydroxyapatite, beta tricalcium phosphate, synthetic, ceramics, spinal fusion, PLF, PLIF, ALIF, and TLIF. Only articles written in English were assessed for appropriate material. Related articles were also assessed depending on the content of articles found in the original literature search. Conclusions Although iliac crest remains the gold standard, reported success with alternative approaches, especially in combination, has shown promise. Stronger evidence with limited sources of potential bias is necessary to provide a clear picture of their clinical efficacy.
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Affiliation(s)
- Kenneth Vaz
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases-Langone Medical Center, New York, NY
| | - Kushagra Verma
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases-Langone Medical Center, New York, NY
| | - Themistocles Protopsaltis
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases-Langone Medical Center, New York, NY
| | - Frank Schwab
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases-Langone Medical Center, New York, NY
| | - Baron Lonner
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases-Langone Medical Center, New York, NY
| | - Thomas Errico
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases-Langone Medical Center, New York, NY
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Wenger M, Markwalder TM. Bryan total disc arthroplasty: a replacement disc for cervical disc disease. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2010; 3:11-24. [PMID: 22915917 PMCID: PMC3417861 DOI: 10.2147/mder.s7605] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Total disc arthroplasty is a new option in the treatment of cervical degenerative disc disease. Several types of cervical disc prostheses currently challenge the gold-standard discectomy and fusion procedures. This review describes the Bryan Cervical Disc System and presents the Bryan prosthesis, its indications, surgical technique, complications, and outcomes, as given in the literature.
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Affiliation(s)
- Markus Wenger
- Neurosurgery, Klinik Beau-Site and Salem-Spital, Berne, Switzerland
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Kubosch D, Milz S, Sprecher CM, Südkamp NP, Müller CA, Strohm PC. Effect of graft size on graft fracture rate after anterior lumbar spinal fusion in a sheep model. Injury 2010; 41:768-71. [PMID: 19740465 DOI: 10.1016/j.injury.2009.08.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Revised: 07/28/2009] [Accepted: 08/17/2009] [Indexed: 02/02/2023]
Abstract
STUDY DESIGN Sheep anterior spinal fusion model with autogenous and xenogenous bone grafts. OBJECTIVE To investigate whether the relationship between cross-sectional area of the bone graft and area of the adjacent vertebral endplates has an effect on graft fracture rate. SUMMARY OF BACKGROUND DATA Anterior spondylodesis with autogenous iliac crest transplant is a frequently performed operation to stabilize spinal motion segments but to date no precise recommendations with respect to minimum graft size are available in the literature. METHODS Anterior spondylodesis using autogenous and xenogenous grafts of constant size in combination with an angular stable plate (Macs TL). Autogenous iliac crest graft was inserted in eight sheep and xenogenic, commercially available bovine graft (Tutobone) in the additional eight animals. The surface areas of the endplates of the fused intervertebral space were calculated using CT scans and contact radiographs of the specimens obtained after 24 weeks. The graft itself was evaluated for fractures and osteolysis. RESULTS A fracture occurred in tricortical, autogenous grafts if the graft cross-sectional area was less than 21% of the area of the adjacent endplates. All xenogenic grafts fractured and therefore a comparable value could not be determined. CONCLUSION The results clearly indicate that the relation between graft cross-sectional area and endplate area defines the survival or fracture of the graft in anterior spinal fusion. Although it is difficult to directly apply the results to the clinical situation it is suggested to choose a sufficiently large graft, in order to reduce the risk of autogenous graft fracture in anterior spondylodesis.
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Affiliation(s)
- David Kubosch
- Department of Orthopaedic and Trauma Surgery, University of Freiburg Medical Center, Hugstetterstr. 55, D-79106 Freiburg im Breisgau, Germany
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Ertan AA, Beriat NC, Gürpinar A, Onur MA, Cehreli MC. Vascular smooth muscle contraction/relaxation of rat carotid artery is not altered by bone grafting substitutes in vitro. Oral Maxillofac Surg 2010; 14:97-104. [PMID: 20039182 DOI: 10.1007/s10006-009-0192-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE The aim of this study was to explore the effects of various bone grafting substitutes (Osteosponge, Perioglas, Tutoplast, and Surgibone) on vascular smooth muscle tonus. METHODS Bilateral carotid arteries were removed from rats and contraction/relaxation of isolated vessel rings were measured before and after contact with the biomaterials and then, for dose-dependent epinephrine and papaverin administrations, by a force displacement transducer. The data of each biomaterial group were collected by a computerized system and corresponding software at a sample rate of 1,000 kHz and were converted to contraction force. RESULTS Vascular contraction forces were influenced in response to biomaterials tested except for Osteosponge (P < 0.05), although the differences between groups were insignificant (P > 0.05). There was a dose-dependent vascular response to epinephrine and papaverine administration upon biomaterial contact (P < 0.05). The dose-dependent vascular responses to epinephrine and papaverine administration were almost similar for all biomaterials tested (P < 0.05), suggesting that the biomaterials led to reversible effects on vascular contraction/relaxation behavior, which resulted in recovery. CONCLUSIONS Osteosponge, Perioglas, Tutoplast, and Surgibone do not alter vascular smooth muscle tonus and vitality and therefore would, presumably, not jeopardize the angiogenesis of fresh blood vessels and full vascularization during tissue healing.
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Affiliation(s)
- Ahmet Atila Ertan
- Faculty of Dentistry, Department of Prosthodontics, Hacettepe University, Sihhiye, Ankara, 06100, Turkey.
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