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Abe T, Miyazaki M, Sako N, Kanezaki S, Tsubouchi Y, Kaku N. Optimal Intermittent Administration Interval of Abaloparatide for Bone Morphogenetic Protein-Induced Bone Formation in a Rat Spinal Fusion Model. Int J Mol Sci 2024; 25:3655. [PMID: 38612467 PMCID: PMC11011974 DOI: 10.3390/ijms25073655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/11/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Both bone morphogenetic protein 2 (BMP-2) and abaloparatide are used to promote bone formation. However, there is no consensus about their optimal administration. We investigated the optimal administration theory for the pairing of BMP-2 and abaloparatide in a rat spinal fusion model. Group I was only implanted in carriers and saline. Carriers with 3 µg of recombinant human BMP-2 (rhBMP-2) were implanted in other groups. Abaloparatide injections were administered three times a week for group III (for a total amount of 120 µg/kg in a week) and six times a week for group IV (for a total amount of 120 µg/kg in a week) after surgery. They were euthanized 8 weeks after the surgery, and we explanted their spines at that time. We assessed them using manual palpation tests, radiography, high-resolution micro-computed tomography (micro-CT), and histological analysis. We also analyzed serum bone metabolism markers. The fusion rate in Groups III and IV was higher than in Group I, referring to the manual palpation tests. Groups III and IV recorded greater radiographic scores than those in Groups I and II, too. Micro-CT analysis showed that Tbs. Sp in Groups III and IV was significantly lower than in Group I. Tb. N in Group IV was significantly higher than in Group I. Serum marker analysis showed that bone formation markers were higher in Groups III and IV than in Group I. On the other hand, bone resorption markers were lower in Group IV than in Group I. A histological analysis showed enhanced trabecular bone osteogenesis in Group IV. Frequent administration of abaloparatide may be suitable for the thickening of trabecular bone structure and the enhancement of osteogenesis in a rat spinal fusion model using BMP-2 in insufficient doses.
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Affiliation(s)
- Tetsutaro Abe
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita 879-5593, Japan; (T.A.); (N.K.)
| | - Masashi Miyazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita 879-5593, Japan; (T.A.); (N.K.)
| | - Noriaki Sako
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita 879-5593, Japan; (T.A.); (N.K.)
| | - Shozo Kanezaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita 879-5593, Japan; (T.A.); (N.K.)
| | - Yuta Tsubouchi
- School of Physical Therapy, Faculty of Rehabilitation, Reiwa Health Sciences University, Fukuoka 811-0213, Japan
| | - Nobuhiro Kaku
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita 879-5593, Japan; (T.A.); (N.K.)
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Rowe ET, Takagi-Stewart J, Ramtin S, Pennington M, Ilyas AM. The Effect of Nonsteroidal Anti-inflammatory Drugs on Union Rates Following Joint Arthrodesis: A Meta-Analysis. Cureus 2024; 16:e56312. [PMID: 38629002 PMCID: PMC11020629 DOI: 10.7759/cureus.56312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2024] [Indexed: 04/19/2024] Open
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most widely used and prescribed medications because of their important role in reducing inflammation and pain, in addition to their non-addictive properties and safety profiles. However, some studies have documented an association between NSAIDs and delayed union or nonunion of joint arthrodesis procedures due to a potential inhibition of the bone's inflammatory healing response. As a result, some orthopedic surgeons hesitate to prescribe NSAIDs after an arthrodesis procedure. The purpose of this meta-analysis is to review all relevant literature regarding the effect of NSAIDs on union rates after arthrodesis and determine if NSAID therapy increases the risk of non-union in the setting of arthrodesis procedures. The study hypothesis was that NSAIDs would not have a significant effect on the risk of nonunion after arthrodesis. A thorough systematic review of Medline, Embase, the Cochrane Database of Systematic Reviews, and the Web of Science identified 3,050 articles to be screened. The variables of interest encompassed demographic factors, procedural details, type and administration of NSAIDs, the number of patients exposed to NSAIDs with and without successful union (case group), as well as the number of patients who did not receive NSAIDs with and without successful union (control group). All the data were analyzed using a maximum likelihood random-effects model. The number of non-union events versus routine healing from each study was used to calculate the odds ratio (OR) of successful healing after arthrodesis procedures with versus without NSAID therapy. Thirteen articles met the inclusion criteria for the meta-analysis. NSAID exposure showed an increased risk of nonunion, delayed union, or both following arthrodesis procedures; however, this did not meet statistical significance (OR, 1.48; confidence interval [CI], 0.96 to 2.30). A sub-analysis of pediatric and adult studies showed a significant increase in non-union risk in adults (OR, 1.717; CI, 1.012 to 2.914) when removing the pediatric cohort (p = 0.045). This meta-analysis provides evidence that NSAIDs can increase the risk of nonunion, delayed union, or both following arthrodesis procedures in adults. However, the study did not identify a risk of nonunion, delayed union, or both following arthrodesis procedures in the pediatric population.
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Affiliation(s)
- Emerson T Rowe
- Orthopedic Surgery, Drexel University College of Medicine, Philadelphia, USA
| | | | - Sina Ramtin
- Hand Department, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Margaret Pennington
- Division of Hand Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, USA
| | - Asif M Ilyas
- Orthopedic Surgery, Drexel University College of Medicine, Philadelphia, USA
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Xu Q, Torres JE, Hakim M, Babiak PM, Pal P, Battistoni CM, Nguyen M, Panitch A, Solorio L, Liu JC. Collagen- and hyaluronic acid-based hydrogels and their biomedical applications. MATERIALS SCIENCE & ENGINEERING. R, REPORTS : A REVIEW JOURNAL 2021; 146:100641. [PMID: 34483486 PMCID: PMC8409465 DOI: 10.1016/j.mser.2021.100641] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Hydrogels have been widely investigated in biomedical fields due to their similar physical and biochemical properties to the extracellular matrix (ECM). Collagen and hyaluronic acid (HA) are the main components of the ECM in many tissues. As a result, hydrogels prepared from collagen and HA hold inherent advantages in mimicking the structure and function of the native ECM. Numerous studies have focused on the development of collagen and HA hydrogels and their biomedical applications. In this extensive review, we provide a summary and analysis of the sources, features, and modifications of collagen and HA. Specifically, we highlight the fabrication, properties, and potential biomedical applications as well as promising commercialization of hydrogels based on these two natural polymers.
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Affiliation(s)
- Qinghua Xu
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, Indiana 47907, United States
| | - Jessica E. Torres
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, Indiana 47907, United States
| | - Mazin Hakim
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana 47907, USA
| | - Paulina M Babiak
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, Indiana 47907, United States
| | - Pallabi Pal
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, Indiana 47907, United States
| | - Carly M Battistoni
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, Indiana 47907, United States
| | - Michael Nguyen
- Department of Biomedical Engineering, University of California Davis, Davis, California 95616, United States
| | - Alyssa Panitch
- Department of Biomedical Engineering, University of California Davis, Davis, California 95616, United States
| | - Luis Solorio
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana 47907, USA
| | - Julie C. Liu
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, Indiana 47907, United States
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana 47907, USA
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Abe T, Miyazaki M, Ishihara T, Kanezaki S, Tsubouchi Y, Tsumura H. Optimal intermittent administration interval of parathyroid hormone 1-34 for bone morphogenetic protein-induced bone formation in a rat spinal fusion model. JOR Spine 2021; 4:e1168. [PMID: 34611590 PMCID: PMC8479526 DOI: 10.1002/jsp2.1168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/16/2021] [Accepted: 07/23/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Both bone morphogenetic protein 2 (BMP-2) and teriparatide (parathyroid hormone [PTH] 1-34) are used to enhance bone healing. There is still no established opinion regarding the optimum dose and administration method. We investigated the optimal administration method for the combination of BMP-2 and PTH 1-34 in a rat spinal fusion model. METHODS Group I was implanted with a control carrier. Groups II, III, and IV were implanted with a carrier containing 3 μg of recombinant human BMP-2 (rhBMP-2). In addition, following implantation, PTH 1-34 injections were administered to Group III thrice a week (total, 180 μg/kg/week) and Group IV six times a week (total, 180 μg/kg/week). The rats were euthanized after 8 weeks, and their spines were explanted; assessed by manual palpation, radiographs, and high-resolution micro-computed tomography (micro-CT); and subjected to histological analysis. Serum markers of bone metabolism were also analyzed. RESULTS Manual palpation tests showed that the fusion rates in Groups III and IV were considerably higher than those in Group I. They also had higher radiographic scores than Group I and II. Micro-CT analysis revealed Tb.Th in the Group IV had higher values than that in the Group I, II, III with significant differences and Tb.Sp in the Group IV had lower values than that in the Group I, II, III with significant differences. Serum marker analysis revealed that Group IV had higher osteocalcin and lower tartrate-resistant acid phosphatase-5b than Group III. Histological analysis indicated that Group IV had enhanced trabecular bone structure. CONCLUSIONS Frequent administration of PTH may be better in making thicker and strengthening the trabecular bone structure in newly formed bone in the rat spinal fusion model using insufficient BMP-2.
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Affiliation(s)
- Tetsutaro Abe
- Faculty of Medicine, Department of Orthopedic SurgeryOita UniversityOitaJapan
| | - Masashi Miyazaki
- Faculty of Medicine, Department of Orthopedic SurgeryOita UniversityOitaJapan
| | - Toshinobu Ishihara
- Faculty of Medicine, Department of Orthopedic SurgeryOita UniversityOitaJapan
| | - Shozo Kanezaki
- Faculty of Medicine, Department of Orthopedic SurgeryOita UniversityOitaJapan
| | | | - Hiroshi Tsumura
- Faculty of Medicine, Department of Orthopedic SurgeryOita UniversityOitaJapan
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Shahrestani S, Ballatori AM, Chen X, Ton A, Wang JC, Buser Z. The Impact of Osteobiologic Subtype Selection on Perioperative Complications and Hospital-Reported Charges in Single- and Multi-Level Lumbar Spinal Fusion. Int J Spine Surg 2021; 15:654-662. [PMID: 34266932 DOI: 10.14444/8086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Over the last several decades, various osteobiologics including allograft, synthetics, and growth factors have been used for lumbar spinal fusion surgery. However, the data on these osteobiologic products remain controversial with conflicting evidence in the literature. This study evaluates the influence of osteobiologic type selection on perioperative complications and hospital-reported charges in single-level and multilevel lumbar fusion. METHODS Using the 2016 and 2017 Nationwide Readmission Database, we conducted a retrospective cohort analysis of 125,143 patients who received lumbar fusion with either autologous tissue substitute, nonautologous tissue substitute, or synthetic substitute. This cohort was split into single-level and multilevel fusion procedures, and one-to-one age and sex propensity score matching was implemented. This resulted in cohorts each consisting of 1967 patients for single-level fusion, and cohorts each consisting of 1657 patients for multilevel fusion. Statistical analysis included one-way analysis of variance and Tukey multiple comparisons of means. RESULTS Autologous single-level fusion resulted in significantly more postoperative pain at 30-, 90-, and 180-day follow-up compared to fusion with nonautologous graft (P < .05). Multilevel fusion with autologous graft had higher rates of acute postsurgical anemia compared with synthetic (P = .021) and nonautologous (P = .016) alternatives, and less postsurgical infection when compared with nonautologous fusion (P = .0020). In addition, procedures using autologous osteobiologics were associated with significantly more neurological complications at 30 days (P = .049) and 90 days (P = .048) for multi-level fusion and at 30 days (P = .044) for single-level fusion compared with the nonautologous group. Lastly, for both cohorts, the total accrued inpatient hospital charges during admission for patients receiving nonautologous grafts were the most expensive and those for patients receiving autologous grafts were the least expensive. CONCLUSION Significant differences were found between the groups with respect to rates of complications, including infection, postoperative pain, and neurologic injury. Furthermore, the hospital-reported charges of each procedure varied significantly. As the field of biologics continues to expand, it is important to continually evaluate the safety, efficacy, and cost-effectiveness of these novel materials and techniques. LEVEL OF EVIDENCE 3 CLINICAL RELEVANCE: With increased utilization of osteobiologics and spinal fusion being a common procedure, longitudinal data on readmissions, and post-operative complications are critical in guiding evidence-based practice.
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Affiliation(s)
- Shane Shahrestani
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California.,Department of Medical Engineering, California Institute of Technology, Pasadena, California
| | - Alexander M Ballatori
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Xiao Chen
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Andy Ton
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jeffrey C Wang
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Zorica Buser
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
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Terauchi M, Tamura A, Arisaka Y, Masuda H, Yoda T, Yui N. Cyclodextrin-Based Supramolecular Complexes of Osteoinductive Agents for Dental Tissue Regeneration. Pharmaceutics 2021; 13:136. [PMID: 33494320 PMCID: PMC7911178 DOI: 10.3390/pharmaceutics13020136] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/13/2021] [Accepted: 01/18/2021] [Indexed: 12/16/2022] Open
Abstract
Oral tissue regeneration has received growing attention for improving the quality of life of patients. Regeneration of oral tissues such as alveolar bone and widely defected bone has been extensively investigated, including regenerative treatment of oral tissues using therapeutic cells and growth factors. Additionally, small-molecule drugs that promote bone formation have been identified and tested as new regenerative treatment. However, treatments need to progress to realize successful regeneration of oral functions. In this review, we describe recent progress in development of regenerative treatment of oral tissues. In particular, we focus on cyclodextrin (CD)-based pharmaceutics and polyelectrolyte complexation of growth factors to enhance their solubility, stability, and bioactivity. CDs can encapsulate hydrophobic small-molecule drugs into their cavities, resulting in inclusion complexes. The inclusion complexation of osteoinductive small-molecule drugs improves solubility of the drugs in aqueous solutions and increases in vitro osteogenic differentiation efficiency. Additionally, various anionic polymers such as heparin and its mimetic polymers have been developed to improve stability and bioactivity of growth factors. These polymers protect growth factors from deactivation and degradation by complex formation through electrostatic interaction, leading to potentiation of bone formation ability. These approaches using an inclusion complex and polyelectrolyte complexes have great potential in the regeneration of oral tissues.
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Affiliation(s)
- Masahiko Terauchi
- Department of Maxillofacial Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo, Tokyo 113-8549, Japan; (M.T.); (H.M.); (T.Y.)
| | - Atsushi Tamura
- Department of Organic Biomaterials, Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University (TMDU), 2-3-10 Kanda-Surugadai, Chiyoda, Tokyo 101-0062, Japan; (Y.A.); (N.Y.)
| | - Yoshinori Arisaka
- Department of Organic Biomaterials, Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University (TMDU), 2-3-10 Kanda-Surugadai, Chiyoda, Tokyo 101-0062, Japan; (Y.A.); (N.Y.)
| | - Hiroki Masuda
- Department of Maxillofacial Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo, Tokyo 113-8549, Japan; (M.T.); (H.M.); (T.Y.)
| | - Tetsuya Yoda
- Department of Maxillofacial Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo, Tokyo 113-8549, Japan; (M.T.); (H.M.); (T.Y.)
| | - Nobuhiko Yui
- Department of Organic Biomaterials, Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University (TMDU), 2-3-10 Kanda-Surugadai, Chiyoda, Tokyo 101-0062, Japan; (Y.A.); (N.Y.)
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Applications of Bone Morphogenetic Proteins in Dentistry: A Bibliometric Analysis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5971268. [PMID: 33163536 PMCID: PMC7604587 DOI: 10.1155/2020/5971268] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 10/06/2020] [Accepted: 10/12/2020] [Indexed: 12/12/2022]
Abstract
Background Many articles on bone morphogenetic proteins (BMPs) have been published. Bibliometric analysis is helpful to determine the most influential studies in a specific field. This bibliometric analysis is aimed at identifying and analyzing the top 50 most-cited articles on the dental applications of BMPs. Methods An electronic search was conducted using the Web of Science (WoS) “All Databases” without any restriction of language, study design, or publication year. Of 1341 publications, the top 50 were included based on their citation count. After downloading the full texts, their bibliometric data including publication title, authorship, citation count, current citation index 2019, citation density, year of publication, country and institution of origin, journal of publication, type of BMP, study design, evidence level of publication, and keywords were extracted and analyzed. Results The citation counts for the top 50 publications ranged from 81 to 557 (median 113.5). The most prolific year was 1997 (n = 7). Wikesjö UM (n = 12) and Wozney JM (n = 11) were the major contributors in this study. Most of the articles were generated primarily from the USA (n = 24), with Loma Linda University Medical Center, USA being the most prolific institution (n = 5). Majority of the articles were published in the Clinical Oral Implants Research and Journal of Periodontology, with nine publications each. Most of the publications were animal studies (n = 30) and focused on BMP-2 (n = 39). Most of the articles were within evidence level V (n = 36). The most frequently used keyword in the top articles was “bone regeneration” (n = 23). Conclusion The present study presents insights into the past and recent trends in the applications of BMPs in dentistry. A statistically significant association was observed between citation count, citation density, and age of publication.
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Pereira HF, Cengiz IF, Silva FS, Reis RL, Oliveira JM. Scaffolds and coatings for bone regeneration. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2020; 31:27. [PMID: 32124052 DOI: 10.1007/s10856-020-06364-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 02/13/2020] [Indexed: 05/28/2023]
Abstract
Bone tissue has an astonishing self-healing capacity yet only for non-critical size defects (<6 mm) and clinical intervention is needed for critical-size defects and beyond that along with non-union bone fractures and bone defects larger than critical size represent a major healthcare problem. Autografts are, still, being used as preferred to treat large bone defects. Mostly, due to the presence of living differentiated and progenitor cells, its osteogenic, osteoinductive and osteoconductive properties that allow osteogenesis, vascularization, and provide structural support. Bone tissue engineering strategies have been proposed to overcome the limited supply of grafts. Complete and successful bone regeneration can be influenced by several factors namely: the age of the patient, health, gender and is expected that the ideal scaffold for bone regeneration combines factors such as bioactivity and osteoinductivity. The commercially available products have as their main function the replacement of bone. Moreover, scaffolds still present limitations including poor osteointegration and limited vascularization. The introduction of pores in scaffolds are being used to promote the osteointegration as it allows cell and vessel infiltration. Moreover, combinations with growth factors or coatings have been explored as they can improve the osteoconductive and osteoinductive properties of the scaffold. This review focuses on the bone defects treatments and on the research of scaffolds for bone regeneration. Moreover, it summarizes the latest progress in the development of coatings used in bone tissue engineering. Despite the interesting advances which include the development of hybrid scaffolds, there are still important challenges that need to be addressed in order to fasten translation of scaffolds into the clinical scenario. Finally, we must reflect on the main challenges for bone tissue regeneration. There is a need to achieve a proper mechanical properties to bear the load of movements; have a scaffolds with a structure that fit the bone anatomy.
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Affiliation(s)
- Helena Filipa Pereira
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, University of Minho, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal.
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.
- Center for Micro-Electro Mechanical Systems, University of Minho, Azurém Campus, 4800-058, Guimarães, Portugal.
| | - Ibrahim Fatih Cengiz
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, University of Minho, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
- The Discoveries Centre for Regenerative and Precision Medicine, Headquarters at University of Minho, AvePark, Barco, 4805-017, Guimarães, Portugal
| | - Filipe Samuel Silva
- Center for Micro-Electro Mechanical Systems, University of Minho, Azurém Campus, 4800-058, Guimarães, Portugal
| | - Rui Luís Reis
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, University of Minho, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
- The Discoveries Centre for Regenerative and Precision Medicine, Headquarters at University of Minho, AvePark, Barco, 4805-017, Guimarães, Portugal
| | - Joaquim Miguel Oliveira
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, University of Minho, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
- The Discoveries Centre for Regenerative and Precision Medicine, Headquarters at University of Minho, AvePark, Barco, 4805-017, Guimarães, Portugal
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Bhamb N, Kanim LEA, Drapeau S, Mohan S, Vasquez E, Shimko D, McKAY W, Bae HW. Comparative Efficacy of Commonly Available Human Bone Graft Substitutes as Tested for Posterolateral Fusion in an Athymic Rat Model. Int J Spine Surg 2019; 13:437-458. [PMID: 31745449 DOI: 10.14444/6059] [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] [Indexed: 01/08/2023] Open
Abstract
Background Insufficient data exist on bone graft substitute materials efficacy; two thirds lack any clinical data.1,2 This prospective animal study identified efficacy differences among commercially available materials of several classes. Methods Historically validated muscle pouch osteoinduction study (OIS) and posterolateral fusion (PLF) were performed in an athymic rat model. Grafting material products implanted were demineralized bone matrix (DBM)-based allografts (Accell EVO3, DBX Mix, DBX Strip, Grafton Crunch, Grafton Flex, Grafton Matrix, Grafton Putty, Magnifuse, and Progenix Plus), allografts (OsteoSponge, MinerOss), cellular allograft (Osteocel Plus), ceramics (Mozaik Strip), or activated ceramics (Actifuse ABX Putty, Vitoss BA). After 4 weeks, OIS specimens were evaluated ex vivo by histologic osteoinductivity. After 8 weeks, PLF ex vivo specimens were evaluated for fusion by manual palpation (FMP), radiography (FXR), and histology (FHISTO). Results OIS: No materials exhibited a rejection reaction on histology. All DBM-based materials exhibited osteoinductive potential as new bone formation at > 88% of implanted sites. One plain allograft (OsteoSponge) formed bone at 25% of sites. No bone formed for one ceramic (Mozaik Strip), three activated ceramics (Actifuse ABX Putty), or one cellular allograft, regardless of human bone marrow aspirate (hBMA) when added. PLF: Among the 10 DBMs, 6 had FMP of 100% (Accell EVO3, DBX Mix, DBX Strip, Grafton Flex, Grafton Putty, Magnifuse), 2 had FMP of 94% (Grafton Crunch, Grafton Matrix), and 2 conditions had FMP of 0% (Progenix Plus, Progenix Plus + athymic rat iliac crest bone graft [arICBG]). Ceramics (Mozaik Strip), activated ceramics (Actifuse ABX Putty, Vitoss BA), plain allograft (OsteoSponge, MinerOss (PLF study), and cellular allograft (Osteocel Plus) demonstrated 0% FMP. ArICBG demonstrated 13% FMP. Conclusions Eight DBM-based materials (Accell EVO3, DBX Mix, DBX Strip, Grafton Crunch, Grafton Flex, Grafton Matrix, Grafton Putty, Magnifuse) demonstrated excellent (> 90% FMP) efficacy in promoting fusion via bone healing. Two DBM conditions (Progenix Plus, Progenix Plus + arICBG) showed no manual palpation fusion (FMP). Systematically, over the 2 studies (OIS and PLF), cellular (Osteocel Plus), plain allografts (OsteoSponge, MinerOss; PLF study), ceramic (Mozaik Strip), and activated ceramics (Actifuse ABX Putty, Vitoss BA) demonstrated poor FMP efficacy (< 10%). Clinical Relevance When selecting DBMs, clinicians must be cognizant of variability in DBM efficacy by product and lot. While theoretically osteoinductive, cellular allograft and activated ceramics yielded poor in vivo efficacy. Whole allograft and ceramics may provide osteoconductive scaffolding for mixed-material grafting; however, surgeons should be cautious in using them alone. Direct clinical data are needed to establish efficacy for any bone graft substitute.
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Affiliation(s)
- Neil Bhamb
- Cedars-Sinai Medical Center, Los Angeles, California
| | - Linda E A Kanim
- Translational and Clinical Research, Spine Center, Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | | | | | | | - Hyun W Bae
- Cedars-Sinai Medical Center, Los Angeles, California
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Mun HY, Ko MJ, Kim YB, Park SW. Usefulness of Oblique Lateral Interbody Fusion at L5-S1 Level Compared to Transforaminal Lumbar Interbody Fusion. J Korean Neurosurg Soc 2019; 63:723-729. [PMID: 31295977 PMCID: PMC7671784 DOI: 10.3340/jkns.2018.0215] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 04/29/2019] [Indexed: 11/27/2022] Open
Abstract
Objective The use of oblique lateral interbody fusion at the L5–S1 level (OLIF51) is increasing, but no study has directly compared OLIF51 and transforaminal lumbar interbody fusion (TLIF) at the L5–S1 level. We evaluated the usefulness of OLIF51 by comparing clinical and radiologic outcomes with those of TLIF at the same L5–S1 level.
Methods We retrospectively reviewed and compared 74 patients who underwent OLIF51 (OLIF51 group) and 74 who underwent TLIF at the L5–S1 level (TLIF51 group). Clinical outcomes were assessed with the visual analogue scale for back pain and leg pain and the Oswestry Disability Index. Mean disc height (MDH), foraminal height (FH), disc angle (DA), fusion rate, and subsidence rate were measured for radiologic outcomes.
Results The OLIF51 group used significantly higher, wider, and larger-angled cages than the TLIF51 group (p<0.001). The postoperative MDH and FH were significantly greater in the OLIF51 group than in the TLIF51 group (p<0.001). The postoperative DA was significantly larger in the OLIF51 group than in the TLIF51 group by more than 10º (p<0.001). The fusion rate was 81.1% and 87.8% at postoperative 6 months in the OLIF51 and TLIF51 groups, respectively, and the TLIF51 group showed a higher fusion rate (p<0.05). The subsidence rate was 16.2% and 25.3% in the OLIF51 and TLIF51 groups, respectively, and the OLIF51 group showed a lower subsidence rate (p<0.05).
Conclusion OLIF51 was more effective for the indirect decompression of foraminal stenosis, providing strong mechanical support with a larger cage, and making a greater lordotic angle with a high-angle cage than with TLIF.
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Affiliation(s)
- Hah Yong Mun
- Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Myeong Jin Ko
- Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Young Baeg Kim
- Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Seung Won Park
- Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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Samra H, Abdulla S, Elias GJB, Murphy KJ. Why Do We Believe What We Believe? J Vasc Interv Radiol 2018; 29:1754-1755. [PMID: 30502879 DOI: 10.1016/j.jvir.2018.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 05/08/2018] [Accepted: 05/25/2018] [Indexed: 11/24/2022] Open
Affiliation(s)
- Humraaz Samra
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sarah Abdulla
- Department of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Gavin J B Elias
- Department of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Kieran J Murphy
- Department of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
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Notani N, Miyazaki M, Toyoda M, Kanezaki S, Ishihara T, Tsumura H. Enhancing the effects of exfoliated carbon nanofibers using bone morphogenetic protein in a rat spinal fusion model. J Orthop Res 2018; 36:2892-2900. [PMID: 29917272 DOI: 10.1002/jor.24073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 06/11/2018] [Indexed: 02/04/2023]
Abstract
Exfoliated carbon nanofibers (ExCNFs) are expected to serve as excellent scaffolds for promoting and guiding bone-tissue regeneration. We aimed to enhance the effects of ExCNFs using bone morphogenetic proteins (BMPs) and examined their feasibility and safety in clinical applications using a rat spinal fusion model. Group I (n = 15) animals were implanted with the control carrier; Group II (n = 16) animals were implanted with carrier containing 1 μg ExCNFs; Group III (n = 16) animals were implanted with carrier containing 1 μg recombinant human (rh) BMP-2; and Group IV (n = 17) animals were implanted with carrier containing 1 μg rhBMP-2 and 1 μg ExCNFs. The rats were euthanized after 4 or 8 weeks and their spines were explanted and assessed by manual palpation, radiographs, and high-resolution microcomputerized tomography (micro-CT); the spines were also subjected to histological analysis. The fusion rates in Group IV (25.0%: 4-week, 45.5%: 8-week) were considerably higher than in Groups I (0%: 4-week, 0%: 8-week), II (0%: 4-week, 15.0%: 8-week), and III (16.7%: 4-week, 30.0%: 8-week). These results demonstrated the enhancement of ExCNF bone fusion effects by BMP in a rat spinal fusion model. Our results suggest that the enhancement of ExCNFs effects by BMP makes this combination a possible attractive therapy for spinal fusion surgeries. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2892-2900, 2018.
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Affiliation(s)
- Naoki Notani
- Faculty of Medicine, Department of Orthopaedic Surgery, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita 879-5593, Japan
| | - Masashi Miyazaki
- Faculty of Medicine, Department of Orthopaedic Surgery, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita 879-5593, Japan
| | - Masahiro Toyoda
- Faculty of Engineering, Department of Applied Chemistry, Oita University, Oita, Japan
| | - Shozo Kanezaki
- Faculty of Medicine, Department of Orthopaedic Surgery, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita 879-5593, Japan
| | - Toshinobu Ishihara
- Faculty of Medicine, Department of Orthopaedic Surgery, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita 879-5593, Japan
| | - Hiroshi Tsumura
- Faculty of Medicine, Department of Orthopaedic Surgery, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita 879-5593, Japan
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A Prospective, Randomized, Multicenter Study Comparing Silicated Calcium Phosphate versus BMP-2 Synthetic Bone Graft in Posterolateral Instrumented Lumbar Fusion for Degenerative Spinal Disorders. Spine (Phila Pa 1976) 2018; 43:E860-E868. [PMID: 29652784 DOI: 10.1097/brs.0000000000002678] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective, Phase IV, multicenter, randomized study. OBJECTIVE The aim of this study was to compare vertebral fusion success rates following posterolateral fusion [(PLF)/posterolateral intertransverse fusion (PITF)] surgery. The surgical procedure combined posterior lumbar interbody fusion (PLIF) and PLF with internal fixation over one or two levels using silicated calcium phosphate (SiCaP) or bone morphogenetic protein (BMP)-2 as graft material in patients with a degenerative disorder of the lumbar spine. SUMMARY OF BACKGROUND DATA Few controlled trials have evaluated the bone graft materials available to surgeons treating patients with spinal disorders, including degenerative disc disease, spondylolisthesis, and disc herniation. METHODS Following randomization, the surgical procedure consisting of PLIF and PLF with internal fixation over one or two levels was performed using SiCaP or BMP-2. No other osteoconductive/osteoinductive graft materials were permitted. Spinal fusion was assessed radiographically at ≤24 months. Clinical outcomes (pain on visual analog scale, Oswestry Disability Index, SF-36) and adverse events (AEs) were monitored. RESULTS One hundred three patients were enrolled. At 12 months, fusion was achieved in 25 of 35 (71.4%) of the SiCaP and 20 of 27 (74.1%) of the BMP-2 group, respectively (P = 1.000). At 24 months, the fusion rate was 78.6% and 84.8% for SiCaP and BMP-2, respectively (P = 0.5613). Clinical outcomes improved similarly in both groups over time. AEs were consistent with this surgical population. CONCLUSION SiCaP was safe and well tolerated in patients with degenerative spinal disorders requiring PLF and provided fusion rates similar to BMP-2. LEVEL OF EVIDENCE 2.
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Alobaidaan R, Cohen JR, Lord EL, Buser Z, Yoon ST, Youssef JA, Park JB, Brodke DS, Wang JC, Meisel HJ. Complication Rates in Posterior Lumbar Interbody Fusion (PLIF) Surgery With Human Bone Morphogenetic Protein 2: Medicare Population. Global Spine J 2017; 7:770-773. [PMID: 29238641 PMCID: PMC5721992 DOI: 10.1177/2192568217696695] [Citation(s) in RCA: 3] [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] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study among Medicare beneficiaries who underwent posterior lumbar interbody fusion (PLIF) surgery. OBJECTIVE To identify the complication rates associated with the use of bone morphogenetic protein 2 (BMP2) in PLIF. Human BMP2 is commonly used in the "off-label" manner for various types of spine fusion procedures, including PLIF. However, recent studies have reported potential complications associated with the recombinant human BMP2 (rhBMP2) use in the posterior approach. METHODS Medicare records within the PearlDiver database were queried for patients undergoing PLIF procedure with and without rhBMP2 between 2005 and 2010. We evaluated complications within 1 year postoperatively. Chi-square was used to compare the complication rates between the 2 groups. RESULTS A total of 8609 patients underwent PLIF procedure with or without rhBMP2. Individual complication rates in the rhBMP2 group ranged from 0.45% to 7.68% compared with 0.65% to 10.99 in the non-rhBMP2 group. Complication rates for cardiac, pulmonary, lumbosacral neuritis, infection, wound, and urinary tract (include acute kidney failure and post-operative complications) were significantly lower in the rhBMP2 group (P < .05). There was no difference in the rates of central nervous system complications or radiculitis between the 2 groups. CONCLUSION Our data showed that the patients who received rhBMP2 had lower complication rates compared to the non-rhBMP2 group. However, use of rhBMP2 was associated with a higher rate of pseudarthrosis. We did not observe any difference in radiculitis and central nervous system complications between the groups.
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Affiliation(s)
| | | | | | - Zorica Buser
- University of Southern California, Los Angeles, CA, USA,Zorica Buser, Department of Orthopaedic Surgery, Elaine Stevely Hoffman Medical Research Center, Keck School of Medicine, University of Southern California, HMR 710, 2011 Zonal Avenue, Los Angeles, CA 90033, USA.
| | | | - Jim A. Youssef
- Durango Orthopedic Associates, Spine Colorado, Durango, CO, USA
| | - Jong-Beom Park
- Uijongbu St Mary’s Hospital, The Catholic University of Korea, Uijongbu, Korea
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Imagama S, Ando K, Kobayashi K, Ishikawa Y, Nakamura H, Hida T, Ito K, Tsushima M, Matsumoto A, Morozumi M, Tanaka S, Machino M, Ota K, Nakashima H, Takamatsu J, Matsushita T, Nishida Y, Ishiguro N, Matsuyama Y. Efficacy of Early Fusion With Local Bone Graft and Platelet-Rich Plasma in Lumbar Spinal Fusion Surgery Followed Over 10 Years. Global Spine J 2017; 7:749-755. [PMID: 29238638 PMCID: PMC5721988 DOI: 10.1177/2192568217696690] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
STUDY DESIGN Prospective clinical study. OBJECTIVE Many oral surgeons use platelet-rich plasma (PRP) for bone defects, but the efficacy of PRP for spinal arthrodesis remains uncertain. The objective was to compare the efficacy of autologous local bone graft and PRP with local bone graft alone for promotion of bony union in posterolateral lumbar fusion (PLF) surgery, with investigation of the safety of PRP over 10 years. METHODS A prospective study was conducted in 29 consecutive patients who underwent one-level PLF at L4/5 for degenerative lumbar disease. Local bone on the left (control) side and local bone with PRP on the right side were grafted. The fusion area and absorption of grafted bone at 58 regions were determined using computed tomography at 2 weeks and 3, 6, and 12 months after surgery. RESULTS Average bone fusion areas on the PRP side were significantly wider at 3 and 6 months after surgery (P < .05). Average absorption values were significantly lower on the PRP side than on the control side at 3 and 6 months after surgery (P < .05). The PRP/control ratio was significantly different at 3 and 6 months compared to that at 2 weeks (P < .005). No adverse events related to PRP occurred with good clinical outcome over 10 years follow-up. CONCLUSIONS Local application of PRP combined with autologous local bone graft has a positive impact on early fusion for lumbar arthrodesis with no adverse events over 10 years, and thus is a safe and low cost autologous option in spinal fusion.
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Affiliation(s)
- Shiro Imagama
- Nagoya University Graduate School of Medicine, Department of Orthopaedic Surgery, Nagoya, Aichi, Japan,Shiro Imagama, Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, Japan.
| | - Kei Ando
- Nagoya University Graduate School of Medicine, Department of Orthopaedic Surgery, Nagoya, Aichi, Japan
| | - Kazuyoshi Kobayashi
- Nagoya University Graduate School of Medicine, Department of Orthopaedic Surgery, Nagoya, Aichi, Japan
| | - Yoshimoto Ishikawa
- Nagoya University Graduate School of Medicine, Department of Orthopaedic Surgery, Nagoya, Aichi, Japan
| | | | - Tetsuro Hida
- Nagoya University Graduate School of Medicine, Department of Orthopaedic Surgery, Nagoya, Aichi, Japan
| | - Kenyu Ito
- Nagoya University Graduate School of Medicine, Department of Orthopaedic Surgery, Nagoya, Aichi, Japan
| | - Mikito Tsushima
- Nagoya University Graduate School of Medicine, Department of Orthopaedic Surgery, Nagoya, Aichi, Japan
| | - Akiyuki Matsumoto
- Nagoya University Graduate School of Medicine, Department of Orthopaedic Surgery, Nagoya, Aichi, Japan
| | - Masayoshi Morozumi
- Nagoya University Graduate School of Medicine, Department of Orthopaedic Surgery, Nagoya, Aichi, Japan
| | - Satoshi Tanaka
- Nagoya University Graduate School of Medicine, Department of Orthopaedic Surgery, Nagoya, Aichi, Japan
| | - Masaaki Machino
- Nagoya University Graduate School of Medicine, Department of Orthopaedic Surgery, Nagoya, Aichi, Japan
| | - Kyotaro Ota
- Nagoya University Graduate School of Medicine, Department of Orthopaedic Surgery, Nagoya, Aichi, Japan
| | - Hiroaki Nakashima
- Nagoya University Graduate School of Medicine, Department of Orthopaedic Surgery, Nagoya, Aichi, Japan
| | - Junki Takamatsu
- Japan Red Cross Tokai-Hokuriku Block Blood Center, Seto, Aichi, Japan
| | - Tadashi Matsushita
- Nagoya University Hospital, Department of Transfusion Medicine, Nagoya, Aichi, Japan
| | - Yoshihiro Nishida
- Nagoya University Graduate School of Medicine, Department of Orthopaedic Surgery, Nagoya, Aichi, Japan
| | - Naoki Ishiguro
- Nagoya University Graduate School of Medicine, Department of Orthopaedic Surgery, Nagoya, Aichi, Japan
| | - Yukihiro Matsuyama
- Hamamatsu University School of Medicine, Department of Orthopaedic Surgery, Hamamatsu, Shizuoka, Japan
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Abstract
STUDY DESIGN Retrospective database review. OBJECTIVE OF THE STUDY The objective of the study was to assess whether bone morphogenetic protein (BMP) decreases the risk of revision surgery in elderly patients treated with 3-7 level or 8 or greater level fusions. SUMMARY OF BACKGROUND DATA Revision spine surgery in the elderly is a complex undertaking, highlighting the importance of discovering methods to decrease the risk of repeat procedures. The role of BMP in modulating risk of future revision surgery is not well studied in the elderly. MATERIALS AND METHODS The PearlDiver database (2005-2012) was queried for elderly adult spinal deformity patients treated with a primary thoracolumbar posterolateral fusion of 3 or more levels. To compare how BMP modifies revision surgery rates in 3-7 level versus 8 level or greater fusions, 4 mutually exclusive cohorts were created and matched to one another: 1043 patients treated with 8 or greater level fusions with BMP; 1111 patients with 8 or greater level fusions without BMP; 2813 patients with 3-7 level fusions with BMP; and 4770 patients with 3-7 level fusions without BMP. Revision and complication rates were compared. Complications included seroma formation, heterotopic ossification, and postoperative neuritis within 90 days. RESULTS Patients treated with BMP during an 8 or greater level fusion were significantly less likely to require a revision surgery than matched controls (relative risk, 0.75, P=0.015). BMP use was not associated with a decreased risk of revision surgery in 3-7 level fusions (relative risk, 0.89, P=0.20). Patients treated with BMP during 3-7 level fusions were significantly less likely to develop any of the assessed complications (P=0.02). There were no other significant differences in pairwise comparisons of subcohorts of each of the fusion lengths. CONCLUSIONS BMP use decreases revision rates in elderly adult spinal deformity patients treated with 8 or greater level fusions, but not in those treated with 3-7 level fusions. LEVEL OF EVIDENCE Level III.
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Lykissas M, Gkiatas I. Use of recombinant human bone morphogenetic protein-2 in spine surgery. World J Orthop 2017; 8:531-535. [PMID: 28808623 PMCID: PMC5534401 DOI: 10.5312/wjo.v8.i7.531] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 02/05/2017] [Accepted: 04/20/2017] [Indexed: 02/06/2023] Open
Abstract
Bone morphogenetic proteins are osteoinductive factors which have gained popularity in orthopaedic surgery and especially in spine surgery. The use of recombinant human bone morphogenetic protein-2 has been officially approved by the United States Food and Drug Administration only for single level anterior lumbar interbody fusion, nevertheless it is widely used by many surgeons with off-label indications. Despite advantages in bone formation, its use still remains a controversial issue and several complications have been described by authors who oppose their wide use.
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Litrico S, Langlais T, Pennes F, Gennari A, Paquis P. Lumbar interbody fusion with utilization of recombinant human bone morphogenetic protein: a retrospective real-life study about 277 patients. Neurosurg Rev 2017; 41:189-196. [DOI: 10.1007/s10143-017-0834-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 01/29/2017] [Accepted: 02/20/2017] [Indexed: 11/28/2022]
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Begam H, Nandi SK, Kundu B, Chanda A. Strategies for delivering bone morphogenetic protein for bone healing. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2016; 70:856-869. [PMID: 27770964 DOI: 10.1016/j.msec.2016.09.074] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 09/12/2016] [Accepted: 09/29/2016] [Indexed: 12/18/2022]
Abstract
Bone morphogenetic proteins (BMPs) are the most significant growth factors that belong to the Transforming Growth Factor Beta (TGF-β) super-family. Though more than twenty members of this family have been identified so far in humans, Food and Drug Administration (FDA) approved two growth factors: BMP-2 and BMP-7 for treatments of spinal fusion and long-bone fractures with collagen carriers. Currently BMPs are clinically used in spinal fusion, oral and maxillofacial surgery and also in the repair of long bone defects. The efficiency of BMPs depends a lot on the selection of suitable carriers. At present, different types of carrier materials are used: natural and synthetic polymers, calcium phosphate and ceramic-polymer composite materials. Number of research articles has been published on the minute intricacies of the loading process and release kinetics of BMPs. Despite the significant evidence of its potential for bone healing demonstrated in animal models, future clinical investigations are needed to define dose, scaffold and route of administration. The efficacy and application of BMPs in various levels with a proper carrier and dose is yet to be established. The present article collates various aspects of success and limitation and identifies the prospects and challenges associated with the use of BMPs in orthopaedic surgery.
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Affiliation(s)
- Howa Begam
- School of Bioscience and Engineering, Jadavpur University, Kolkata 700032, India
| | - Samit Kumar Nandi
- Department of Veterinary Surgery, Radiology West Bengal University of Animal and Fishery Sciences, Kolkata 700037, India.
| | - Biswanath Kundu
- Bioceramics and Coating Division, CSIR-Central Glass and Ceramic Research Institute, Kolkata 700032, India.
| | - Abhijit Chanda
- Department of Mechanical Engineering, Jadavpur University, Kolkata 700032, India
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Kadam A, Millhouse PW, Kepler CK, Radcliff KE, Fehlings MG, Janssen ME, Sasso RC, Benedict JJ, Vaccaro AR. Bone substitutes and expanders in Spine Surgery: A review of their fusion efficacies. Int J Spine Surg 2016; 10:33. [PMID: 27909654 DOI: 10.14444/3033] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
STUDY DESIGN A narrative review of literature. OBJECTIVE This manuscript intends to provide a review of clinically relevant bone substitutes and bone expanders for spinal surgery in terms of efficacy and associated clinical outcomes, as reported in contemporary spine literature. SUMMARY OF BACKGROUND DATA Ever since the introduction of allograft as a substitute for autologous bone in spinal surgery, a sea of literature has surfaced, evaluating both established and newly emerging fusion alternatives. An understanding of the available fusion options and an organized evidence-based approach to their use in spine surgery is essential for achieving optimal results. METHODS A Medline search of English language literature published through March 2016 discussing bone graft substitutes and fusion extenders was performed. All clinical studies reporting radiological and/or patient outcomes following the use of bone substitutes were reviewed under the broad categories of Allografts, Demineralized Bone Matrices (DBM), Ceramics, Bone Morphogenic proteins (BMPs), Autologous growth factors (AGFs), Stem cell products and Synthetic Peptides. These were further grouped depending on their application in lumbar and cervical spine surgeries, deformity correction or other miscellaneous procedures viz. trauma, infection or tumors; wherever data was forthcoming. Studies in animal populations and experimental in vitro studies were excluded. Primary endpoints were radiological fusion rates and successful clinical outcomes. RESULTS A total of 181 clinical studies were found suitable to be included in the review. More than a third of the published articles (62 studies, 34.25%) focused on BMP. Ceramics (40 studies) and Allografts (39 studies) were the other two highly published groups of bone substitutes. Highest radiographic fusion rates were observed with BMPs, followed by allograft and DBM. There were no significant differences in the reported clinical outcomes across all classes of bone substitutes. CONCLUSIONS There is a clear publication bias in the literature, mostly favoring BMP. Based on the available data, BMP is however associated with the highest radiographic fusion rate. Allograft is also very well corroborated in the literature. The use of DBM as a bone expander to augment autograft is supported, especially in the lumbar spine. Ceramics are also utilized as bone graft extenders and results are generally supportive, although limited. The use of autologous growth factors is not substantiated at this time. Cell matrix or stem cell-based products and the synthetic peptides have inadequate data. More comparative studies are needed to evaluate the efficacy of bone graft substitutes overall.
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Affiliation(s)
- Abhijeet Kadam
- Pennsylvania Hospital of the University of Pennsylvania Health System, Philadelphia, PA
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Pakzaban P. Modified Mini-open Transforaminal Lumbar Interbody Fusion: Description of Surgical Technique and Assessment of Free-hand Pedicle Screw Insertion. Spine (Phila Pa 1976) 2016; 41:E1124-E1130. [PMID: 26909829 PMCID: PMC5001135 DOI: 10.1097/brs.0000000000001510] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective case series. OBJECTIVE To describe a modified technique for mini-open transforaminal lumbar interbody fusion (TLIF) that improves visualization for decompression, fusion, and freehand pedicle screw insertion. Accuracy of freehand pedicle screw placement with this technique was assessed. SUMMARY OF BACKGROUND DATA Mini-open TLIF is a minimally invasive technique that allows limited visualization of the bone and neural anatomy via an expandable tubular retractor inserted through the Wiltse plane. No significant modification that of this technique has been described in detail. METHODS In this study, 92 consecutive patients underwent one-level modified mini-open TLIF (MOTLIF). MOTLIF modifications consisted of (i) transmuscular dissection through the multifidus muscle rather than intermuscular dissection in the Wiltse plane; (ii) microsurgical detachment of multifidus from the facet rather than muscle dilation; (iii) en bloc total facetectomy (unilateral or bilateral, as needed for decompression); (iv) facet autograft used for interbody fusion; and (v) solid pedicle screws placed bilaterally by a freehand technique under direct vision. RESULTS The mean age was 53 years. Mean follow-up was 35 months (minimum 2 yrs). By 6 months, mean Visual Analog Scale for back and leg pain had improved from 51 to 19 and from 58 to 17, respectively, and mean Oswestry Disability Index (ODI) improved from 53 to 16. These improvements persisted at 2 years. Solid fusion, defined by computed tomography at 1 year, was achieved in 88.1%, whereas satisfactory fusion was achieved in 95.2% of patients. Pedicle screws were accurately placed in 335 of 336 imaged pedicles (pedicle breach grades: 91.1% grade 1; 8.6% grade 2; and 0.3% grade 3). Mean fluoroscopy time was 29.3 seconds. CONCLUSION MOTLIF is a safe and effective minimally invasive technique with a high fusion rate. It allows accurate pedicle screw placement by a freehand technique. By eliminating bi-planar fluoroscopy, it helps reduce radiation exposure. This is the largest published report of mini-open TLIF to date. LEVEL OF EVIDENCE 4.
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Schmitt PJ, Kelleher JP, Ailon T, Heller JE, Kasliwal MK, Shaffrey CI, Smith JS. Long-Segment Fusion for Adult Spinal Deformity Correction Using Low-Dose Recombinant Human Bone Morphogenetic Protein-2. Neurosurgery 2016; 79:212-21. [DOI: 10.1227/neu.0000000000001194] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Abstract
BACKGROUND:
Although use of very high-dose recombinant human bone morphogenetic protein-2 (rhBMP-2) has been reported to markedly improve fusion rates in adult spinal deformity (ASD) surgery, most centers use much lower doses due to cost constraints. How effective these lower doses are for fusion enhancement remains unclear.
OBJECTIVE:
To assess fusion rates using relatively low-dose rhBMP-2 for ASD surgery.
METHODS:
This was a retrospective review of consecutive ASD patients that underwent thoracic to sacral fusion. Patients that achieved 2-year follow-up were analyzed. Impact of patient and surgical factors on fusion rate was assessed, and fusion rates were compared with historical cohorts.
RESULTS:
Of 219 patients, 172 (78.5%) achieved 2-year follow-up and were analyzed. Using an average rhBMP-2 dose of 3.1 mg/level (average total dose = 35.9 mg/case), the 2-year fusion rate was 73.8%. Cancellous allograft, local autograft, and very limited iliac crest bone graft (<20 mL, obtained during iliac bolt placement) were also used. On multivariate analysis, female sex was associated with a higher fusion rate, whereas age, comorbidity score, deformity type, and 3-column osteotomy were not. There were no complications directly attributable to rhBMP-2.
CONCLUSION:
Fusion rates for ASD using low-dose rhBMP-2 were comparable to those reported for iliac crest bone graft but lower than for high-dose rhBMP-2. Importantly, there were substantial differences between patients in the present series and those in the historical comparison groups that could not be fully adjusted for based on available data. Prospective evaluation of rhBMP-2 dosing for ASD surgery is warranted to define the most appropriate dose that balances benefits, risks, and costs.
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Affiliation(s)
- Paul J. Schmitt
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - John P. Kelleher
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Tamir Ailon
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Joshua E. Heller
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Manish K. Kasliwal
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Christopher I. Shaffrey
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Justin S. Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
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Ruofeng Y, Cohen JR, Buser Z, Yoon ST, Meisel HJ, Youssef JA, Park JB, Wang JC, Brodke DS. Trends of Posterior Long Segment Fusion with and without Recombinant Human Bone Morphogenetic Protein 2 in Patients with Scoliosis. Global Spine J 2016; 6:422-31. [PMID: 27433425 PMCID: PMC4947408 DOI: 10.1055/s-0035-1564416] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 08/06/2015] [Indexed: 11/03/2022] Open
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE Symptomatic scoliosis can be a source of severe pain and disability. When nonoperative treatments fail, spine fusion is considered as an effective procedure in scoliosis management. The purpose of this study was to evaluate the trends of patients with scoliosis undergoing posterior long segment fusion (PLSF) with and without recombinant human bone morphogenetic protein 2 (rhBMP-2). METHODS Patients within the orthopedic subset of Medicare database undergoing PLSF from 2005 to 2011 were identified using the PearlDiver Patient Records Database. Both diagnosis and procedural International Classification of Diseases, ninth edition and Current Procedural Terminology codes were used. The year of procedure, age, sex, region, and rhBMP-2 use were recorded. RESULTS In total, 1,265,591 patients with scoliosis were identified with 29,787 PLSF surgeries between 2005 and 2011. The incidence of PLSF procedures increased gradually from 2005 to 2009, decreased in 2010 (p < 0 0.01), and grew again in 2011. Patients over age 84 years had the highest incidence of PLSF. The lowest incidence of the procedures was in the Northeast, 5.96 per 100,000 patients. Sex differences were observed with a male-to-female ratio of 0.40 (p < 0.01). The use of rhBMP-2 for PLSF increased steadily from 2005 to 2009; the numbers dropped dramatically in 2010 and returned by 2011. CONCLUSIONS According to our study, patients with scoliosis demonstrated a 0.6575 average incidence increase of PLSF treatments annually. There were significant differences in incidence of PLSF procedure and patient demographics. Additionally, rhBMP-2 consumption significantly changed when we stratified it by sex, age, and region respectively.
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Affiliation(s)
- Yin Ruofeng
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, California, United States,Department of Orthopedic Surgery, China-Japan Union Hospital, Jilin University, ChangChun City, JiLin Province, China
| | - Jeremiah R. Cohen
- Department of Orthopaedic Surgery, University of California at Los Angeles, Los Angeles, California, United States
| | - Zorica Buser
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, California, United States,Address for correspondence Zorica Buser, PhD Department of Orthopaedic Surgery, Keck School of MedicineUniversity of Southern California, Elaine Stevely Hoffman Medical Research CenterHMR 710, 2011 Zonal Avenue, Los Angeles, CA 90033United States
| | - S. Tim Yoon
- Department of Orthopedics, Emory Spine Center, Atlanta, Georgia, United States
| | | | - Jim A. Youssef
- Durango Orthopedic Associates, P.C./Spine Colorado, Durango, Colorado, United States
| | - Jong-Beom Park
- Department of Orthopaedic Surgery, Uijongbu St. Mary's Hospital, The Catholic University of Korea School of Medicine, Uijongbu, Korea
| | - Jeffrey C. Wang
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, California, United States
| | - Darrel S. Brodke
- Department of Orthopedics, University of Utah School of Medicine, Salt Lake City, Utah, United States
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Kim DH, Lee N, Shin DA, Yi S, Kim KN, Ha Y. Matched Comparison of Fusion Rates between Hydroxyapatite Demineralized Bone Matrix and Autograft in Lumbar Interbody Fusion. J Korean Neurosurg Soc 2016; 59:363-7. [PMID: 27446517 PMCID: PMC4954884 DOI: 10.3340/jkns.2016.59.4.363] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 01/31/2016] [Accepted: 02/26/2016] [Indexed: 11/27/2022] Open
Abstract
Objective To compare the fusion rate of a hydroxyapatite demineralized bone matrix (DBM) with post-laminectomy acquired autograft in lumbar interbody fusion surgery and to evaluate the correlation between fusion rate and clinical outcome. Methods From January 2013 to April 2014, 98 patients underwent lumbar interbody fusion surgery with hydroxyapatite DBM (HA-DBM group) in our institute. Of those patients, 65 received complete CT scans for 12 months postoperatively in order to evaluate fusion status. For comparison with autograft, we selected another 65 patients who underwent lumbar interbody fusion surgery with post-laminectomy acquired autograft (Autograft group) during the same period. Both fusion material groups were matched in terms of age, sex, body mass index (BMI), and bone mineral density (BMD). To evaluate the clinical outcomes, we analyzed the results of visual analogue scale (VAS), Oswestry Disability Index (ODI), and Short Form Health Survey (SF-36). Results We reviewed the CT scans of 149 fusion levels in 130 patients (HA-DBM group, 75 levels/65 patients; Autograft group, 74 levels/65 patients). Age, sex, BMI, and BMD were not significantly different between the groups (p=0.528, p=0.848, p=0.527, and p=0.610, respectively). The HA-DBM group showed 39 of 75 fused levels (52%), and the Autograft group showed 46 of 74 fused levels (62.2%). This difference was not statistically significant (p=0.21). In the HA-DBM group, older age and low BMD were significantly associated with non-fusion (61.24 vs. 66.68, p=0.027; -1.63 vs. -2.29, p=0.015, respectively). VAS and ODI showed significant improvement after surgery when fusion was successfully achieved in both groups (p=0.004, p=0.002, HA-DBM group; p=0.012, p=0.03, Autograft group). Conclusion The fusion rates of the hydroxyapatite DBM and Autograft groups were not significantly different. In addition, clinical outcomes were similar between the groups. However, older age and low BMD are risk factors that might induce non-union after surgery with hydroxyapatite DBM.
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Affiliation(s)
- Dae Hwan Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Nam Lee
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Ah Shin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Yi
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Keung Nyun Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
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Toth JM, Wang M, Lawson J, Badura JM, DuBose KB. Radiographic, biomechanical, and histological evaluation of rhBMP-2 in a 3-level intertransverse process spine fusion: an ovine study. J Neurosurg Spine 2016; 25:733-739. [PMID: 27367941 DOI: 10.3171/2016.4.spine151316] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate bone grafts consisting of rhBMP-2 on an absorbable collagen sponge with a ceramic composite bulking agent, rhBMP-2, directly on a ceramic-collagen sponge carrier or iliac crest bone graft (ICBG) in combination with local bone graft to effect fusion in a multisegmental instrumented ovine lumbar intertransverse process fusion model. METHODS Thirty-six sheep had a single treatment at 3 spinal levels in both the right and left intertransverse process spaces. Group 1 sheep were treated with 7.5 cm3 of autograft consisting of ICBG plus local bone for each intertransverse process space. For Groups 2-4, 4 cm3 of local bone was placed within the intertransverse process space followed by 4.5-5 cm3 of the rhBMP-2 graft material. Group 2 animals received 1.5 mg/cm3 rhBMP-2 on an absorbable collagen sponge with a commercial bone void filler consisting of Type I lyophilized collagen with a biphasic hydroxyapatite/β-tricalcium phosphate ceramic with local bone. Group 3 animals received 0.75 mg/m cm3 of rhBMP-2 on a collagen ceramic sponge carrier with local bone. Group 4 animals received 1.35 mg/cm3 of rhBMP-2 on the same collagen ceramic sponge carrier with local bone. Sheep were euthanized 6 months postoperatively. Manual palpation, biomechanical testing, CT, radiography, and undecalcified histology were performed to assess the presence of fusion associated with the treatments. RESULTS All animals in Groups 2-4 that received grafts containing rhBMP-2 achieved radiographic and CT fusion at all 3 levels. In Group 1 (bone autograft alone), only 19% of the levels demonstrated radiographic fusion, 14% resulted in possible radiographic fusion, and 67% of the levels demonstrated radiographic nonfusion. Biomechanical testing showed that Groups 2-4 demonstrated similar stiffness of the L2-5 segment in all 6 loading directions, with each of the 3 groups having significantly greater stiffness than the autograft-only group. In Group 1, only 2 of 18 levels were rated as achieving bilateral histological fusion, with an additional 3 levels showing a unilateral fusion. The majority of the treated levels (13/18) in Group 1 were scored as histological nonfusions. There were no histological nonfusions in Groups 2 through 4. All 18 levels in Group 2 were rated as bilateral histological fusions. A majority (34/36) of the levels in Group 3 were rated as bilateral histological fusions, with 2 levels showing a unilateral fusion. A majority (35/36) of the levels in Group 4 were rated as bilateral histological fusions, with 1 level showing a unilateral fusion. CONCLUSIONS In the ovine multilevel instrumented intertransverse process fusion model, rhBMP-2 was able to consistently achieve CT, radiographic, biomechanical, and histological fusion. Compared with ICBG, the gold standard for bone grafting, rhBMP-2 was statistically superior at achieving radiographic and histological fusion.
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Affiliation(s)
- Jeffrey M Toth
- Department of Orthopaedic Surgery, The Medical College of Wisconsin Inc., Milwaukee, Wisconsin; and
| | - Mei Wang
- Department of Orthopaedic Surgery, The Medical College of Wisconsin Inc., Milwaukee, Wisconsin; and
| | - Joshua Lawson
- Department of Orthopaedic Surgery, The Medical College of Wisconsin Inc., Milwaukee, Wisconsin; and
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Bodalia PN, Balaji V, Kaila R, Wilson L. Effectiveness and safety of recombinant human bone morphogenetic protein-2 for adults with lumbar spine pseudarthrosis following spinal fusion surgery: A systematic review. Bone Joint Res 2016; 5:145-52. [PMID: 27121215 PMCID: PMC4921046 DOI: 10.1302/2046-3758.54.2000418] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 02/16/2016] [Indexed: 01/18/2023] Open
Abstract
Objectives We performed a systematic review of the literature to determine the safety and efficacy of bone morphogenetic protein (BMP) compared with bone graft when used specifically for revision spinal fusion surgery secondary to pseudarthrosis. Methods The MEDLINE, EMBASE and Cochrane Library databases were searched using defined search terms. The primary outcome measure was spinal fusion, assessed as success or failure in accordance with radiograph, MRI or CT scan review at 24-month follow-up. The secondary outcome measure was time to fusion. Results A total of six studies (three prospective and three retrospective) reporting on the use of BMP2 met the inclusion criteria (203 patients). Of these, four provided a comparison of BMP2 and bone graft whereas the other two solely investigated the use of BMP2. The primary outcome was seen in 92.3% (108/117) of patients following surgery with BMP2. Although none of the studies showed superiority of BMP2 to bone graft for fusion, its use was associated with a statistically quicker time to achieving fusion. BMP2 did not appear to increase the risk of complication. Conclusion The use of BMP2 is both safe and effective within the revision setting, ideally in cases where bone graft is unavailable or undesirable. Further research is required to define its optimum role. Cite this article: Mr P. Bodalia. Effectiveness and safety of recombinant human bone morphogenetic protein-2 for adults with lumbar spine pseudarthrosis following spinal fusion surgery: A systematic review. Bone Joint Res 2016;5:145–152. DOI: 10.1302/2046-3758.54.2000418.
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Affiliation(s)
- P N Bodalia
- Department of Pharmacy, University College London Hospitals, 235 Euston Road, London, NW1 2BU, UK
| | - V Balaji
- West Hertfordshire Hospitals NHS Trust, Spinal Surgery Unit, Watford General Hospital, Vicarage Road, Watford, Hertfordshire, WD18 0HB, UK
| | - R Kaila
- Spinal Surgery, Spinal Deformity Unit, Royal National Orthopaedic Hospital NHS Trust, Middlesex, HA7 4LP, UK
| | - L Wilson
- Spinal Deformity Unit, Royal National Orthopaedic Hospital NHS Trust, Middlesex, HA7 4LP, UK
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McCarthy B, Yuan Y, Koria P. Elastin-like-polypeptide based fusion proteins for osteogenic factor delivery in bone healing. Biotechnol Prog 2016; 32:1029-37. [PMID: 27038196 DOI: 10.1002/btpr.2269] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 03/22/2016] [Indexed: 11/11/2022]
Abstract
Modern treatments of bone injuries and diseases are becoming increasingly dependent on the usage of growth factors to stimulate bone growth. Bone morphogenetic protein-2 (BMP-2), a potent osteogenic inductive protein, exhibits promising results in treatment models, but recently has had its practical efficacy questioned due to the lack of local retention, ectopic bone formation, and potentially lethal inflammation. Where a new delivery technique of the BMP-2 is necessary, here we demonstrate the viability of an elastin-like peptide (ELP) fusion protein containing BMP-2 for delivery of the BMP-2. This fusion protein retains the performance characteristics of both the BMP-2 and ELP. The fusion protein was found to induce osteogenic differentiation of mesenchymal stem cells as evidenced by the production of alkaline phosphatase and extracellular calcium deposits in response to treatment by the fusion protein. Retention of the ELPs inverse phase transition property has allowed for expression of the fusion protein within a bacterial host (such as Escherichia coli) and easy and rapid purification using inverse transition cycling. The fusion protein formed self-aggregating nanoparticles at human-body temperature. The data collected suggests the viability of these fusion protein nanoparticles as a dosage-efficient and location-precise noncytotoxic delivery vehicle for BMP-2 in bone treatment. © 2016 American Institute of Chemical Engineers Biotechnol. Prog., 32:1029-1037, 2016.
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Affiliation(s)
- Bryce McCarthy
- Dept. of Chemical and Biomedical Engineering, University of South Florida, Tampa, FL, 33620
| | - Yuan Yuan
- Dept. of Chemical and Biomedical Engineering, University of South Florida, Tampa, FL, 33620
| | - Piyush Koria
- Dept. of Chemical and Biomedical Engineering, University of South Florida, Tampa, FL, 33620
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Kirby GTS, White LJ, Steck R, Berner A, Bogoevski K, Qutachi O, Jones B, Saifzadeh S, Hutmacher DW, Shakesheff KM, Woodruff MA. Microparticles for Sustained Growth Factor Delivery in the Regeneration of Critically-Sized Segmental Tibial Bone Defects. MATERIALS 2016; 9:ma9040259. [PMID: 28773384 PMCID: PMC5502923 DOI: 10.3390/ma9040259] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/18/2016] [Accepted: 03/18/2016] [Indexed: 11/16/2022]
Abstract
This study trialled the controlled delivery of growth factors within a biodegradable scaffold in a large segmental bone defect model. We hypothesised that co-delivery of vascular endothelial growth factor (VEGF) and platelet derived growth factor (PDGF) followed by bone morphogenetic protein-2 (BMP-2) could be more effective in stimulating bone repair than the delivery of BMP-2 alone. Poly(lactic-co-glycolic acid) (PLGA ) based microparticles were used as a delivery system to achieve a controlled release of growth factors within a medical-grade Polycaprolactone (PCL) scaffold. The scaffolds were assessed in a well-established preclinical ovine tibial segmental defect measuring 3 cm. After six months, mechanical properties and bone tissue regeneration were assessed. Mineralised bone bridging of the defect was enhanced in growth factor treated groups. The inclusion of VEGF and PDGF (with BMP-2) had no significant effect on the amount of bone regeneration at the six-month time point in comparison to BMP-2 alone. However, regions treated with VEGF and PDGF showed increased vascularity. This study demonstrates an effective method for the controlled delivery of therapeutic growth factors in vivo, using microparticles.
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Affiliation(s)
- Giles T S Kirby
- Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), Brisban, QLD 4006, Australia.
- School of Pharmacy, University Park, The University of Nottingham, University Park, Nottingham NG7 2RD, UK.
| | - Lisa J White
- School of Pharmacy, University Park, The University of Nottingham, University Park, Nottingham NG7 2RD, UK.
| | - Roland Steck
- Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), Brisban, QLD 4006, Australia.
| | - Arne Berner
- Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), Brisban, QLD 4006, Australia.
- Department of Trauma Surgery, University of Regensburg, Regensburg 93164, Germany.
| | - Kristofor Bogoevski
- Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), Brisban, QLD 4006, Australia.
| | - Omar Qutachi
- School of Pharmacy, University Park, The University of Nottingham, University Park, Nottingham NG7 2RD, UK.
| | - Brendan Jones
- Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), Brisban, QLD 4006, Australia.
| | - Siamak Saifzadeh
- Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), Brisban, QLD 4006, Australia.
| | - Dietmar W Hutmacher
- Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), Brisban, QLD 4006, Australia.
| | - Kevin M Shakesheff
- School of Pharmacy, University Park, The University of Nottingham, University Park, Nottingham NG7 2RD, UK.
| | - Maria A Woodruff
- Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), Brisban, QLD 4006, Australia.
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Minardi S, Corradetti B, Taraballi F, Sandri M, Martinez JO, Powell ST, Tampieri A, Weiner BK, Tasciotti E. Biomimetic Concealing of PLGA Microspheres in a 3D Scaffold to Prevent Macrophage Uptake. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2016; 12:1479-1488. [PMID: 26797709 DOI: 10.1002/smll.201503484] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Indexed: 06/05/2023]
Abstract
Scaffolds functionalized with delivery systems for the release of growth factors is a robust strategy to enhance tissue regeneration. However, after implantation, macrophages infiltrate the scaffold, eventually initiating the degradation and clearance of the delivery systems. Herein, it is hypothesized that fully embedding the poly(d,l-lactide-co-glycolide acid) microspheres (MS) in a highly structured collagen-based scaffold (concealing) can prevent their detection, preserving the integrity of the payload. Confocal laser microscopy reveals that non-embedded MS are easily internalized; when concealed, J774 and bone marrow-derived macrophages (BMDM) cannot detect them. This is further demonstrated by flow cytometry, as a tenfold decrease is found in the number of MS engulfed by the cells, suggesting that collagen can cloak the MS. This correlates with the amount of nitric oxide and tumor necrosis factor-α produced by J774 and BMDM in response to the concealed MS, comparable to that found for non-functionalized collagen scaffolds. Finally, the release kinetics of a reporter protein is preserved in the presence of macrophages, only when MS are concealed. The data provide detailed strategies for fabricating three dimensional (3D) biomimetic scaffolds able to conceal delivery systems and preserve the therapeutic molecules for release.
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Affiliation(s)
- Silvia Minardi
- Department of Regenerative Medicine, Houston Methodist Research Institute (HMRI), 6670 Bertner Ave., Houston, TX, 77030, USA
- Institute of Science and Technology for Ceramics-CNR (ISTEC-CNR), Via Granarolo 64, 48018, Faenza, RA, Italy
| | - Bruna Corradetti
- Department of Regenerative Medicine, Houston Methodist Research Institute (HMRI), 6670 Bertner Ave., Houston, TX, 77030, USA
- Department of Life and Environmental Sciences, Università Politecnica delle Marche, 60131, Ancona, Italy
| | - Francesca Taraballi
- Department of Regenerative Medicine, Houston Methodist Research Institute (HMRI), 6670 Bertner Ave., Houston, TX, 77030, USA
| | - Monica Sandri
- Institute of Science and Technology for Ceramics-CNR (ISTEC-CNR), Via Granarolo 64, 48018, Faenza, RA, Italy
| | - Jonathan O Martinez
- Department of Regenerative Medicine, Houston Methodist Research Institute (HMRI), 6670 Bertner Ave., Houston, TX, 77030, USA
| | - Sebastian T Powell
- Department of Regenerative Medicine, Houston Methodist Research Institute (HMRI), 6670 Bertner Ave., Houston, TX, 77030, USA
| | - Anna Tampieri
- Institute of Science and Technology for Ceramics-CNR (ISTEC-CNR), Via Granarolo 64, 48018, Faenza, RA, Italy
| | - Bradley K Weiner
- Department of Regenerative Medicine, Houston Methodist Research Institute (HMRI), 6670 Bertner Ave., Houston, TX, 77030, USA
- Department of Orthopedic Surgery, Houston Methodist Hospital, 6550 Fannin St., Houston, TX, 77030, USA
| | - Ennio Tasciotti
- Department of Regenerative Medicine, Houston Methodist Research Institute (HMRI), 6670 Bertner Ave., Houston, TX, 77030, USA
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Subramanian S, Mitchell A, Yu W, Snyder S, Uhrich K, O'Connor JP. Salicylic Acid-Based Polymers for Guided Bone Regeneration Using Bone Morphogenetic Protein-2. Tissue Eng Part A 2015; 21:2013-24. [PMID: 25813520 PMCID: PMC4507132 DOI: 10.1089/ten.tea.2014.0455] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 03/16/2015] [Indexed: 01/23/2023] Open
Abstract
Bone morphogenetic protein-2 (BMP-2) is used clinically to promote spinal fusion, treat complex tibia fractures, and to promote bone formation in craniomaxillofacial surgery. Excessive bone formation at sites where BMP-2 has been applied is an established complication and one that could be corrected by guided tissue regeneration methods. In this study, anti-inflammatory polymers containing salicylic acid [salicylic acid-based poly(anhydride-ester), SAPAE] were electrospun with polycaprolactone (PCL) to create thin flexible matrices for use as guided bone regeneration membranes. SAPAE polymers hydrolyze to release salicylic acid, which is a nonsteroidal anti-inflammatory drug. PCL was used to enhance the mechanical integrity of the matrices. Two different SAPAE-containing membranes were produced and compared: fast-degrading (FD-SAPAE) and slow-degrading (SD-SAPAE) membranes that release salicylic acid at a faster and slower rate, respectively. Rat femur defects were treated with BMP-2 and wrapped with FD-SAPAE, SD-SAPAE, or PCL membrane or were left unwrapped. The effects of different membranes on bone formation within and outside of the femur defects were measured by histomorphometry and microcomputed tomography. Bone formation within the defect was not affected by membrane wrapping at BMP-2 doses of 12 μg or more. In contrast, the FD-SAPAE membrane significantly reduced bone formation outside the defect compared with all other treatments. The rapid release of salicylic acid from the FD-SAPAE membrane suggests that localized salicylic acid treatment during the first few days of BMP-2 treatment can limit ectopic bone formation. The data support development of SAPAE polymer membranes for guided bone regeneration applications as well as barriers to excessive bone formation.
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Affiliation(s)
- Sangeeta Subramanian
- Department of Microbiology, Biochemistry and Molecular Genetics, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - Ashley Mitchell
- Department of Microbiology, Biochemistry and Molecular Genetics, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - Weiling Yu
- Department of Biomedical Engineering, School of Engineering, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Sabrina Snyder
- Department of Biomedical Engineering, School of Engineering, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Kathryn Uhrich
- Department of Chemistry and Chemical Biology, School of Arts and Sciences, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - J. Patrick O'Connor
- Department of Microbiology, Biochemistry and Molecular Genetics, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey
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The Fate of L5-S1 With Low-Dose BMP-2 and Pelvic Fixation, With or Without Interbody Fusion, in Adult Deformity Surgery. Spine (Phila Pa 1976) 2015; 40:E634-9. [PMID: 25768688 DOI: 10.1097/brs.0000000000000867] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective comparative case series. OBJECTIVE Evaluate L5-S1 fusion rates when lower dose of bone morphogenic protein-2 (BMP-2) (average 3.2 mg) and pelvic fixation were used, with or without interbody fusion. SUMMARY OF BACKGROUND DATA Pseudarthrosis at L5-S1 is one of the most common complications of long fusions to the sacrum in adult deformity surgery. Strategies for decreasing pseudarthrosis include interbody fusion, use of BMP-2 at the lumbosacral junction, and the use of sacropelvic fixation, individually or in combination. High-dose BMP-2 (20-40 mg) placed posterolaterally has shown comparable fusion rates with interbody fusion. METHODS Retrospective review of 61 consecutive patients with minimum 2-year follow-up at a single institution. All patients had an isolated posterior approach, 5 or more levels fused including L5-S1, use of pelvic fixation, and no prior L5-S1 procedures. The patients were divided in 2 groups for comparison on the basis of the use of an interbody cage/fusion at the L5-S1 level. Revision rates and implant-related complications were also reported. RESULTS The fusion rate at L5-S1 was 97% (59/61), with no difference between the interbody and no interbody fusion groups (97% vs. 96%, P = 1.0). There were no significant differences in the radiographical parameters or deformity correction between the groups. The mean amount of BMP-2 used in the interbody group was 4.1 mg (2-10), 2.5 mg (0-8) in the disc space, and 1.6 mg (0-4) in the interbody cage, whereas there was no difference in the amount of recombinant human bone morphogenic protein-2 placed posterolaterally between the 2 groups (interbody fusion = 1.6 vs. non-interbody fusion = 2.0 mg, P = 0.08) along with autograft and allograft. The overall revision rate for L5-S1 nonunion was 1.6%. CONCLUSION The use of low dose of BMP-2 at the L5-S1 level in combination with sacropelvic fixation achieved satisfactory fusion rates in adult deformity surgery. No additional benefit was encountered by adding an interbody cage. LEVEL OF EVIDENCE 4.
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Glukhikh DL. [The outcomes of arthroplasty in degenerative lesions in the lumbar spine]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2015; 79:68-74. [PMID: 25909747 DOI: 10.17116/neiro201579168-74] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE To investigate the safety and effectiveness of total intervertebral disc replacement with a Maverick prosthesis in patients with discogenic pain in the lower lumbar spine. SUMMARY OF BACKGROUND DATA Lumbar disc arthroplasty has been developed as an alternative to rigid interbody fusion for patients with pathology in the lower lumbar discs. According to the developers, motion preservation in the operated segment should prevent secondary pathology of the adjacent segments. MATERIAL AND METHODS From November 2007 to date, 41 patients have been operated on and 42 disc prostheses have been placed. All patients underwent surgery in the same hospital by the same surgeon. The clinical and radiological results of treatment of 35 patients were studied. The patients were examined before surgery, immediately after surgery and then in the intervals of 3-6, 6-12, 12-24, and 36-48 months. The longest follow-up was 61 months. Mean follow-up was 30 months. RESULTS Patients operated on using total intervertebral disc prosthesis demonstrated a significant improvement compared to their preoperative status. A significant reduction of back and leg pain intensity was observed. The quality of life significantly improved. The intervertebral disc space height, the sagittal balance and the balance in the adjacent levels were restored and preserved after correction. The motion in the implanted segment was preserved. CONCLUSIONS Total lumbar disc replacement with a Maverick prosthesis has proved to be an effective and safe technique. The clinical and radiological methods showed the significant improvement of the patients' status.
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Affiliation(s)
- D L Glukhikh
- District Clinical Hospital 'Center of Traumatology', Tyumen region, Russia
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Lee YS, Kim YB, Park SW, Chung C. Comparison of transforaminal lumbar interbody fusion with direct lumbar interbody fusion: clinical and radiological results. J Korean Neurosurg Soc 2014; 56:469-74. [PMID: 25628805 PMCID: PMC4303721 DOI: 10.3340/jkns.2014.56.6.469] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 06/19/2014] [Accepted: 07/07/2014] [Indexed: 11/27/2022] Open
Abstract
Objective The use of direct lumbar interbody fusion (DLIF) has gradually increased; however, no studies have directly compared DLIF and transforaminal lumbar interbody fusion (TLIF). We compared DLIF and TLIF on the basis of clinical and radiological outcomes. Methods A retrospective review was performed on the medical records and radiographs of 98 and 81 patients who underwent TLIF and DLIF between January 2011 and December 2012. Clinical outcomes were compared with a visual analog scale (VAS) and the Oswestry disability index (ODI). The preoperative and postoperative disc heights, segmental sagittal/coronal angles, and lumbar lordosis were measured on radiographs. Fusion rates, operative time, estimated blood loss (EBL), length of hospital stay, and complications were assessed. Results DLIF was superior to TLIF regarding its ability to restore disc height, foraminal height, and coronal balance (p<0.001). As the extent of surgical level increased, DLIF displayed significant advantages over TLIF considering the operative time and EBL. However, fusion rates at 12 months post-operation were lower for DLIF (87.8%) than for TLIF (98.1%) (p=0.007). The changes of VAS and ODI between the TLIF and DLIF were not significantly different (p>0.05). Conclusion Both DLIF and TLIF are less invasive and thus good surgical options for treating degenerative lumber diseases. DLIF has higher potential in increasing neural foramina and correcting coronal balance, and involves a shorter operative time and reduced EBL, in comparison with TLIF. However, DLIF displayed a lower fusion rate than TLIF, and caused complications related to the transpsoas approach.
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Affiliation(s)
- Young Seok Lee
- Department of Neurosurgery, Chung-Ang University Hospital, Seoul, Korea
| | - Young Baeg Kim
- Department of Neurosurgery, Chung-Ang University Hospital, Seoul, Korea
| | - Seung Won Park
- Department of Neurosurgery, Chung-Ang University Hospital, Seoul, Korea
| | - Chan Chung
- Department of Neurosurgery, Dongguk University Gyeongju Hospital, Gyeongju, Korea
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Kaiser MG, Groff MW, Watters WC, Ghogawala Z, Mummaneni PV, Dailey AT, Choudhri TF, Eck JC, Sharan A, Wang JC, Dhall SS, Resnick DK. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 16: bone graft extenders and substitutes as an adjunct for lumbar fusion. J Neurosurg Spine 2014; 21:106-32. [PMID: 24980593 DOI: 10.3171/2014.4.spine14325] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
In an attempt to enhance the potential to achieve a solid arthrodesis and avoid the morbidity of harvesting autologous iliac crest bone (AICB) for a lumbar fusion, numerous alternatives have been investigated. The use of these fusion adjuncts has become routine despite a lack of convincing evidence demonstrating a benefit to justify added costs or potential harm. Potential alternatives to AICB include locally harvested autograft, calcium-phosphate salts, demineralized bone matrix (DBM), and the family of bone morphogenetic proteins (BMPs). In particular, no option has created greater controversy than the BMPs. A significant increase in the number of publications, particularly with respect to the BMPs, has taken place since the release of the original guidelines. Both DBM and the calciumphosphate salts have demonstrated efficacy as a graft extender or as a substitute for AICB when combined with local autograft. The use of recombinant human BMP-2 (rhBMP-2) as a substitute for AICB, when performing an interbody lumbar fusion, is considered an option since similar outcomes have been observed; however, the potential for heterotopic bone formation is a concern. The use of rhBMP-2, when combined with calcium phosphates, as a substitute for AICB, or as an extender, when used with local autograft or AICB, is also considered an option as similar fusion rates and clinical outcomes have been observed. Surgeons electing to use BMPs should be aware of a growing body of literature demonstrating unique complications associated with the use of BMPs.
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Affiliation(s)
- Michael G Kaiser
- Department of Neurosurgery, Columbia University, New York, New York
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Lee YS, Park SW, Kim YB. Direct lateral lumbar interbody fusion: clinical and radiological outcomes. J Korean Neurosurg Soc 2014; 55:248-54. [PMID: 25132930 PMCID: PMC4130949 DOI: 10.3340/jkns.2014.55.5.248] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 01/15/2014] [Accepted: 05/15/2014] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE According to the recent development of minimally invasive spinal surgery, direct lumbar interbody fusion (DLIF) was introduced as an effective option to treat lumbar degenerative diseases. However, comprehensive results of DLIF have not been reported in Korea yet. The object of this study is to summarize radiological and clinical outcomes of our DLIF experience. METHODS We performed DLIF for 130 patients from May 2011 to June 2013. Among them, 90 patients, who could be followed up for more than 6 months, were analyzed retrospectively. Clinical outcomes were compared using visual analog scale (VAS) score and Oswestry Disability Index (ODI). Bilateral foramen areas, disc height, segmental coronal and sagittal angle, and regional sagittal angle were measured. Additionally, fusion rate was assessed. RESULTS A total of 90 patients, 116 levels, were underwent DLIF. The VAS and ODI improved statistically significant after surgery. All the approaches for DLIF were done on the left side. The left and right side foramen area changed from 99.5 mm(2) and 102.9 mm(2) to 159.2 mm(2) and 151.2 mm(2) postoperatively (p<0.001). Pre- and postoperative segmental coronal and sagittal angles changed statistically significant from 4.1° and 9.9° to 1.1° and 11.1°. Fusion rates of 6 and 12 months were 60.9% and 87.8%. Complications occurred in 17 patients (18.9%). However, most of the complications were resolved within 2 months. CONCLUSION DLIF is not only effective for indirect decompression and deformity correction but also shows satisfactory mechanical stability and fusion rate.
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Affiliation(s)
- Young Seok Lee
- Department of Neurosurgery, Chung-Ang University Hospital, Seoul, Korea
| | - Seung Won Park
- Department of Neurosurgery, Chung-Ang University Hospital, Seoul, Korea
| | - Young Baeg Kim
- Department of Neurosurgery, Chung-Ang University Hospital, Seoul, Korea
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Han X, Zhang W, Gu J, Zhao H, Ni L, Han J, Zhou Y, Gu Y, Zhu X, Sun J, Hou X, Yang H, Dai J, Shi Q. Accelerated postero-lateral spinal fusion by collagen scaffolds modified with engineered collagen-binding human bone morphogenetic protein-2 in rats. PLoS One 2014; 9:e98480. [PMID: 24869484 PMCID: PMC4037187 DOI: 10.1371/journal.pone.0098480] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 05/04/2014] [Indexed: 11/18/2022] Open
Abstract
Bone morphogenetic protein-2 (BMP-2) is a potent osteoinductive cytokine that plays a critical role in bone regeneration and repair. However, its distribution and side effects are major barriers to its success as therapeutic treatment. The improvement of therapy using collagen delivery matrices has been reported. To investigate a delivery system on postero-lateral spinal fusion, both engineered human BMP-2 with a collagen binding domain (CBD-BMP-2) and collagen scaffolds were developed and their combination was implanted into Sprague-Dawley (SD) rats to study Lumbar 4–5 (L4–L5) posterolateral spine fusion. We divided SD rats into three groups, the sham group (G1, n = 20), the collagen scaffold-treated group (G2, n = 20) and the BMP-2-loaded collagen scaffolds group (G3, n = 20). 16 weeks after surgery, the spines of the rats were evaluated by X-radiographs, high-resolution micro-computed tomography (micro-CT), manual palpation and hematoxylin and eosin (H&E) staining. The results showed that spine L4–L5 fusions occurred in G2(40%) and G3(100%) group, while results from the sham group were inconsistent. Moreover, G3 had better results than G2, including higher fusion efficiency (X score, G2 = 2.4±0.163, G3 = 3.0±0, p<0.05), higher bone mineral density (BMD, G2: 0.3337±0.0025g/cm3, G3: 0.4353±0.0234g/cm3. p<0.05) and more bone trabecular formation. The results demonstrated that with site-specific collagen binding domain, a dose of BMP-2 as low as 0.02mg CBD-BMP-2/cm3 collagen scaffold could enhance the posterolateral intertransverse process fusion in rats. It suggested that combination delivery could be an alternative in spine fusion with dramatically decreased side effects caused by high dose of BMP-2.
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Affiliation(s)
- Xinglong Han
- Orthopedic Department, the First Affiliated Hospital of Soochow University, Suzhou, P.R. China
| | - Wen Zhang
- Orthopedic Institute of Soochow University, Suzhou, P.R. China
| | - Jun Gu
- Orthopedic Department, the Second Affiliated Hospital of Soochow University, Suzhou, P.R. China
| | - Huan Zhao
- Orthopedic Department, the First Affiliated Hospital of Soochow University, Suzhou, P.R. China
| | - Li Ni
- Orthopedic Department, the First Affiliated Hospital of Soochow University, Suzhou, P.R. China
| | - Jiajun Han
- Orthopedic Department, the First Affiliated Hospital of Soochow University, Suzhou, P.R. China
| | - Yun Zhou
- Orthopedic Department, the First Affiliated Hospital of Soochow University, Suzhou, P.R. China
| | - Yannan Gu
- Orthopedic Department, the First Affiliated Hospital of Soochow University, Suzhou, P.R. China
| | - Xuesong Zhu
- Orthopedic Department, the First Affiliated Hospital of Soochow University, Suzhou, P.R. China
| | - Jie Sun
- Division of Nanobiomedicine, Suzhou Institute of Nano-Tech and Nano-Bionics, Chinese Academy of Sciences, Suzhou, P.R. China
| | - Xianglin Hou
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, P.R. China
| | - Huilin Yang
- Orthopedic Department, the First Affiliated Hospital of Soochow University, Suzhou, P.R. China
| | - Jianwu Dai
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, P.R. China
- * E-mail: (QS); (JD)
| | - Qin Shi
- Orthopedic Department, the First Affiliated Hospital of Soochow University, Suzhou, P.R. China
- * E-mail: (QS); (JD)
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Jain A, Hassanzadeh H, Strike SA, Skolasky RL, Riley LH. rhBMP use in cervical spine surgery: associated factors and in-hospital complications. J Bone Joint Surg Am 2014; 96:617-23. [PMID: 24740657 DOI: 10.2106/jbjs.m.00666] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Widespread use of recombinant human bone morphogenetic protein (rhBMP) in cervical spine surgery has continued despite the U.S. Food and Drug Administration's 2008 notification regarding its adverse effects. Our study goals were to analyze how patient, surgical, and institutional factors influenced rhBMP use in cervical spinal fusion surgery and to examine the cervical-spine-specific in-hospital complications associated with rhBMP use. METHODS The Nationwide Inpatient Sample database was used to identify 1,064,372 patients eighteen years or older who had undergone cervical spinal fusion surgery from 2003 through 2010. Of these patients, 84,726 (7.96%) received rhBMP. Multivariate logistic regression models were used to analyze patient, surgical, and institutional factors associated with rhBMP use, and the relationship between rhBMP use and the development of in-hospital complications. RESULTS On multivariate analysis, patient age and sex, insurance type, surgical approach, use of autograft bone, and hospital teaching status, size, and region were significant predictors of rhBMP use. Use of rhBMP was a significant predictor of complications on univariate analysis and on multivariate analysis adjusted for patient age and sex, Charlson comorbidity score, insurance status, surgical approach, autograft bone use, and hospital teaching status, size, and region. Use of rhBMP was significantly associated with the development of dysphagia (prevalence, 2.0%; adjusted odds ratio [OR], 1.53), dysphonia (prevalence, 0.28%; adjusted OR, 1.48), hematoma/seroma formation (prevalence, 0.7%; adjusted OR, 1.24), and neurological complications (prevalence, 0.84%; adjusted OR, 2.0). These complications were most commonly found after anterior cervical fusion surgery. Wound infections and neurological complications were most commonly found after posterior cervical fusion surgery. Dysphagia was most commonly found after circumferential fusion surgery. CONCLUSIONS Indications for rhBMP use for cervical spinal fusion are multifactorial. Its use is associated with a significantly higher likelihood of cervical-spine-specific complications.
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Affiliation(s)
- Amit Jain
- c/o Elaine P. Henze, BJ, ELS, Medical Editor and Director, Editorial Services, Department of Orthopaedic Surgery, The Johns Hopkins University, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, #A665, Baltimore, MD 21224-2780. E-mail address: ehe
| | - Hamid Hassanzadeh
- c/o Elaine P. Henze, BJ, ELS, Medical Editor and Director, Editorial Services, Department of Orthopaedic Surgery, The Johns Hopkins University, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, #A665, Baltimore, MD 21224-2780. E-mail address: ehe
| | - Sophia A Strike
- c/o Elaine P. Henze, BJ, ELS, Medical Editor and Director, Editorial Services, Department of Orthopaedic Surgery, The Johns Hopkins University, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, #A665, Baltimore, MD 21224-2780. E-mail address: ehe
| | - Richard L Skolasky
- c/o Elaine P. Henze, BJ, ELS, Medical Editor and Director, Editorial Services, Department of Orthopaedic Surgery, The Johns Hopkins University, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, #A665, Baltimore, MD 21224-2780. E-mail address: ehe
| | - Lee H Riley
- c/o Elaine P. Henze, BJ, ELS, Medical Editor and Director, Editorial Services, Department of Orthopaedic Surgery, The Johns Hopkins University, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, #A665, Baltimore, MD 21224-2780. E-mail address: ehe
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Complications with the use of bone morphogenetic protein 2 (BMP-2) in spine surgery. Spine J 2014; 14:552-9. [PMID: 24412416 DOI: 10.1016/j.spinee.2013.08.060] [Citation(s) in RCA: 297] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 07/16/2013] [Accepted: 08/23/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Recombinant human bone morphogenetic protein 2 (rhBMP-2) is a very potent osteogenic growth factor that has been used successfully in various spine fusions, obviating the need for autologous iliac crest bone graft harvest and therefore avoiding the associated morbidities. PURPOSE In the past few years, a tremendous increase in rhBMP-2 usage was noted, and concerns regarding costs, benefits, and safety issues were raised by many. The goal of this work was to provide a comprehensive review of the adverse events and complications associated with use of rhBMP-2. STUDY DESIGN Literature review. METHODS This is a review of the current literature on the reported adverse events, complications, and concerns associated with rhBMP-2 use. RESULTS This article discusses the wide spectrum of adverse outcomes related to rhBMP-2 use in the lumbar and the cervical spine; retrograde ejaculation, antibodies formation, postoperative radiculitis, postoperative nerve root injury, ectopic bone formation, vertebral osteolysis/edema, dysphagia and neck swelling, hematoma formation, interbody graft lucency, and wound healing complications are reviewed. Cost-related concerns, dosage considerations, carrier types, and theoretical carcinogenesis concerns were also presented. CONCLUSIONS Despite the excellent spinal fusion rates promoted by this powerful molecule, the increasingly reported adverse outcomes associated with bone morphogenetic protein usage have created real concerns. This article will provide the reader with a good understanding of the reported complications associated with rhBMP-2 use and ultimately help recognize its safety spectrum and limits for better clinical application.
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Robinson Y, Heyde CE, Tschöke SK, Mont MA, Seyler TM, Ulrich SD. Evidence supporting the use of bone morphogenetic proteins for spinal fusion surgery. Expert Rev Med Devices 2014; 5:75-84. [DOI: 10.1586/17434440.5.1.75] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Steeby SF, Jeffries JT, Choma TJ, Kuhns CA. Formation of Abdominal Heterotopic Bone Following the Utilization of Bone Morphogenetic Protein in Anterior Lumbar Spinal Fusion: A Case Report. JBJS Case Connect 2014; 4:e5. [PMID: 29252383 DOI: 10.2106/jbjs.cc.m.00113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Shaun F Steeby
- Department of Orthopaedic Surgery, University of Missouri, Missouri Orthopaedic Institute, 1100 Virginia Avenue, DC953.00, Columbia, MO 65212.
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Khan W, Muntimadugu E, Jaffe M, Domb AJ. Implantable Medical Devices. ADVANCES IN DELIVERY SCIENCE AND TECHNOLOGY 2014. [DOI: 10.1007/978-1-4614-9434-8_2] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/06/2022]
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Kodera R, Miyazaki M, Yoshiiwa T, Kawano M, Kaku N, Tsumura H. Manipulation of anabolic and catabolic responses with bone morphogenetic protein and zoledronic acid in a rat spinal fusion model. Bone 2014; 58:26-32. [PMID: 24103577 DOI: 10.1016/j.bone.2013.09.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 09/25/2013] [Accepted: 09/27/2013] [Indexed: 11/23/2022]
Abstract
Bone fusion involves a complex set of regulated signaling pathways that control the formation of new bone matrix and the resorption of damaged bone matrix at the surgical site. It has been reported that systemically administering a single dose of zoledronic acid (ZA) at the optimal time increases the strength of the bone morphogenetic protein (BMP)-mediated callus. In the present study, we aimed to investigate the effect of BMP-2 and ZA in a rat spinal model. Sixty-seven rats were divided into 6 groups: group I (n=11) animals were implanted with a carrier alone, group II (n=12) animals were implanted with a carrier and a subcutaneous injection of ZA was administered 2weeks after surgery, group III (n=12) animals were implanted with a carrier containing 1μg of rhBMP-2, group IV (n=12) animals were implanted with a carrier containing 1μg of rhBMP-2 and a subcutaneous injection of ZA was administered 2weeks after surgery, group V (n=10) animals were implanted with a carrier containing 3μg of rhBMP-2, and group VI (n=10) animals were implanted with a carrier containing 3μg of rhBMP-2 and a subcutaneous injection of ZA was administered 2weeks after surgery. The rats were euthanized after 6weeks, and their spines were explanted and assessed by manual palpation, radiography, high-resolution micro-computerized tomography (micro-CT), and histologic analysis. The fusion rates in group VI (60%) were considerably higher than those in the groups I (0%), II (0%), III (12.5%), IV (20.8%), and V (35%), (P<0.05). Additionally, the radiographic scores of group VI were higher than those in the other groups, (P<0.05). In micro-CT analysis, the tissue and bone volumes of the callus were significantly higher in group VI than those in the other groups, (P<0.05). The trabecular number was significantly higher and the trabecular spacing was significantly lower in group VI than those in the other groups, (P<0.05). The combination of rhBMP-2 and ZA administered systemically as a single dose at the optimal time was efficacious in our rat spinal fusion model. Our results suggest that this combination facilitates spinal fusion and has potential clinical application.
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Affiliation(s)
- Ryuzo Kodera
- Department of Orthopaedic Surgery, Oita University, Oita, Japan
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Yan L, Chang Z, He B, Liu T, Wang X, Guo H, Hao D. Efficacy of rhBMP-2 versus iliac crest bone graft for posterior C1-C2 fusion in patients older than 60 years. Orthopedics 2014; 37:e51-7. [PMID: 24683657 DOI: 10.3928/01477447-20131219-17] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Few studies have specifically examined the efficacy of recombinant human bone morphogenetic protein-2 (rhBMP-2)/absorbable collagen sponge (ACS) in posterolateral lumbar spine fusion. The purpose of this study was to report the clinical outcomes in elderly patients treated with posterior C1-C2 fusion with iliac crest bone graft (ICBG) plus rhBMP-2/ACS vs ICBG alone. One hundred forty patients older than 60 years were enrolled in this prospective, randomized trial and underwent instrumented C1- C2 fusion. Patients were divided into 2 groups based on fusion material. The ICBG group comprised patients who received ICBG alone, and the rhBMP-2/ACS group comprised patients who received ICBG plus rhBMP-2/ACS. The groups were compared based on operative time, estimated blood loss, hospital length of stay, clinical results, perioperative complications, fusion rate, fusion time, and revision rate. There were no significant differences in operative time, estimated blood loss, length of stay, and intraoperative complications between the 2 groups. Improvements in visual analog scale scores and Japanese Orthopaedic Association scores over the 2-year follow-up period were similar between groups. The fusion rate was 82.4% (56 of 68) in the rhBMP-2/ACS group and 78.7% (52 of 66) in the ICBG group (P=.782). Mean fusion time was 11 days shorter in the rhBMP-2/ACS group (81.8±29.4 days) than in the ICBG group (92.9±23.7 days) (P=.034). There were more wound complications requiring treatment in the rhBMP-2/ACS group (n=6; 8.8%) than in the ICBG group (n=2; 3.0%), although this was not statistically significant (P=.118). The use of rhBMP-2/ACS for posterior C1-C2 fusion appears to result in a relatively shorter fusion time, but there may be an increased risk of posterior cervical wound complications.
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Kinard LA, Dahlin RL, Henslee AM, Spicer PP, Chu CY, Tabata Y, van den Beucken JJJP, Jansen JA, Young S, Wong ME, Kasper FK, Mikos AG. Tissue response to composite hydrogels for vertical bone augmentation in the rat. J Biomed Mater Res A 2013; 102:2079-88. [PMID: 23894052 DOI: 10.1002/jbm.a.34878] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 06/15/2013] [Accepted: 07/12/2013] [Indexed: 11/09/2022]
Abstract
The objective of the present study was to develop a preclinical animal model for evaluating bone augmentation and to examine the level of bone augmentation induced by hydrogel composites. Design criteria outlined for the development of the animal model included rigid immobilization of bilateral implants apposed to the parietal bone of the rat, while avoiding the calvarial sutures. The animal model was evaluated through the implantation of hydrogel composites of oligo(poly(ethylene glycol) fumarate) (OPF) and gelatin microparticles releasing bone morphogenetic protein-2 (BMP-2). The BMP-2 release profile was varied and compared to the implantation of a material control without BMP-2. Each hydrogel composite was implanted within a polypropylene cassette, which was immobilized to the calvarial bone using screws, and empty cassettes were implanted as a control. The design criteria for the animal model were realized; however, the level of bone augmentation did not vary between any of the groups after 4 weeks. Osteoclastic bone resorption occurred to a higher extent in groups releasing BMP-2, but the cause could not be elucidated. In conclusion, a promising bone augmentation model was established in the rat; however, refinement of the hydrogel composites was suggested to optimize the constructs for bone augmentation applications.
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Affiliation(s)
- Lucas A Kinard
- Department of Chemical and Biomolecular Engineering, Rice University, Houston, Texas
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Use of recombinant human bone morphogenetic protein-2 with local bone graft instead of iliac crest bone graft in posterolateral lumbar spine arthrodesis. Spine (Phila Pa 1976) 2013; 38:E738-47. [PMID: 23474598 DOI: 10.1097/brs.0b013e31828fd23c] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective clinical study. OBJECTIVE Compare fusion rates between recombinant human bone morphogenetic protein-2 (rhBMP-2) and iliac crest bone graft (ICBG) with rhBMP-2 and local bone graft (LBG) (±bone graft extenders) in posterolateral fusion. SUMMARY OF BACKGROUND DATA Previous reports have shown higher fusion rates when adding rhBMP-2 to ICBG in lumbar posterolateral fusion, compared with ICBG alone. We compared the fusion success rates between rhBMP-2 delivered with ICBG versus that with LBG. METHODS Fusion rates were compared in patients with degenerative spondylolisthesis (1-2 levels) with accompanying lumbar stenosis. RhBMP-2 (INFUSE, Medtronic) was delivered on an absorbable collagen sponge (6 mg/side at 1.5 mg/mL) with ICBG alone or with LBG wrapped inside the sponge. Thin slice computed tomographic scans were assessed at 6, 12, and 24 months. RESULTS In a consecutive series, 16 patients (30 levels) received ICBG with rhBMP-2 and 35 patients (49 levels) received LBG with rhBMP-2. For the ICBG cohort, 80.0%, 93.4%, 96.7% of levels were fused at 6, 12, and 24 months. In contrast, for the local bone with rhBMP-2 cohort, 87.7%, 98.0%, and 98.0% were fused at 6, 12, and 24 months. There was no statistically significant difference in fusion success rates between the 2 groups at any time point. As for fusion quality, the fusion mass showed superior quality in ICBG group than in the local bone group at each time point. CONCLUSION This study validates the high fusion success rates previously reported by adding rhBMP-2 to ICBG and shows that local bone may be safely substituted for ICBG in 1- to 2-level posterolateral fusion. The fusion rates were comparable. The avoidance of ICBG harvest has implications for operative time, blood loss, and morbidity. Lastly, this is the first study that directly compares the fusion success rate and quality using local bone with rhBMP-2 versus ICBG with rhBMP-2 at various times. LEVEL OF EVIDENCE 4.
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Porosity of β-Tricalcium Phosphate Affects the Results of Lumbar Posterolateral Fusion. ACTA ACUST UNITED AC 2013; 26:E40-5. [DOI: 10.1097/bsd.0b013e31823db5e6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cottrell JA, Keshav V, Mitchell A, O'Connor JP. Local inhibition of 5-lipoxygenase enhances bone formation in a rat model. Bone Joint Res 2013; 2:41-50. [PMID: 23610701 PMCID: PMC3626215 DOI: 10.1302/2046-3758.22.2000066] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 01/09/2013] [Indexed: 12/20/2022] Open
Abstract
Objectives Recent studies have shown that modulating inflammation-related
lipid signalling after a bone fracture can accelerate healing in
animal models. Specifically, decreasing 5-lipoxygenase (5-LO) activity
during fracture healing increases cyclooxygenase-2 (COX-2) expression
in the fracture callus, accelerates chondrogenesis and decreases
healing time. In this study, we test the hypothesis that 5-LO inhibition
will increase direct osteogenesis. Methods Bilateral, unicortical femoral defects were used in rats to measure
the effects of local 5-LO inhibition on direct osteogenesis. The
defect sites were filled with a polycaprolactone (PCL) scaffold
containing 5-LO inhibitor (A-79175) at three dose levels, scaffold
with drug carrier, or scaffold only. Drug release was assessed in
vitro. Osteogenesis was assessed by micro-CT and histology
at two endpoints of ten and 30 days. Results Using micro-CT, we found that A-79175, a 5-LO inhibitor, increased
bone formation in an apparent dose-related manner. Conclusions These results indicate that 5-LO inhibition could be used therapeutically
to enhance treatments that require the direct formation of bone.
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Affiliation(s)
- J A Cottrell
- University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Department of Biochemistry & Molecular Biology, Newark, New Jersey, USA
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48
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Tohmeh AG, Watson B, Tohmeh M, Zielinski XJ. Allograft cellular bone matrix in extreme lateral interbody fusion: preliminary radiographic and clinical outcomes. ScientificWorldJournal 2012; 2012:263637. [PMID: 23251099 PMCID: PMC3518059 DOI: 10.1100/2012/263637] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Accepted: 09/02/2012] [Indexed: 11/29/2022] Open
Abstract
Introduction. Extreme lateral interbody fusion (XLIF) is a minimally disruptive alternative for anterior lumbar interbody fusion. Recently, synthetic and allograft materials have been increasingly used to eliminate donor-site pain and complications secondary to autogenous bone graft harvesting. The clinical use of allograft cellular bone graft has potential advantages over autograft by eliminating the need to harvest autograft while mimicking autograft's biologic function. The objective of this study was to examine 12-month radiographic and clinical outcomes in patients who underwent XLIF with Osteocel Plus, one such allograft cellular bone matrix. Methods. Forty (40) patients were treated at 61 levels with XLIF and Osteocel Plus and included in the analysis. Results. No complications were observed. From preoperative to 12-month postoperative followup, ODI improved 41%, LBP improved 55%, leg pain improved 43.3%, and QOL (SF-36) improved 56%. At 12 months, 92% reported being “very” or “somewhat” satisfied with their outcome and 86% being either “very” or “somewhat likely” to choose to undergo the procedure again. Complete fusion was observed in 90.2% (55/61) of XLIF levels. Conclusions. Complete interbody fusion with Osteocel Plus was shown in 90.2% of XLIF levels, with the remaining 9.8% being partially consolidated and progressing towards fusion at 12 months.
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49
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Hsu WK, Nickoli MS, Wang JC, Lieberman JR, An HS, Yoon ST, Youssef JA, Brodke DS, McCullough CM. Improving the clinical evidence of bone graft substitute technology in lumbar spine surgery. Global Spine J 2012; 2:239-48. [PMID: 24353975 PMCID: PMC3864464 DOI: 10.1055/s-0032-1315454] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 03/02/2012] [Indexed: 11/20/2022] Open
Abstract
Bone graft substitutes have been used routinely for spine fusion for decades, yet clinical evidence establishing comparative data remains sparse. With recent scrutiny paid to the outcomes, complications, and costs associated with osteobiologics, a need to improve available data guiding efficacious use exists. We review the currently available clinical literature, studying the outcomes of various biologics in posterolateral lumbar spine fusion, and establish the need for a multicenter, independent osteobiologics registry.
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Affiliation(s)
- Wellington K. Hsu
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois,Address for correspondence and reprint requests Wellington K. Hsu, M.D. Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine676 N. St. Clair Street, #1350Chicago, IL 60611
| | - M. S. Nickoli
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - J. C. Wang
- Department of Orthopaedic Surgery, UCLA Comprehensive Spine Center, Santa Monica, California
| | - J. R. Lieberman
- University of Connecticut Medical Center, Farmington, Connecticut
| | - H. S. An
- Rush University Medical Center, Chicago, Illinois
| | | | | | | | - C. M. McCullough
- Resources for Medical Education and Collaboration, Durango, Colorado
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50
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Studies of bone morphogenetic protein-based surgical repair. Adv Drug Deliv Rev 2012; 64:1277-91. [PMID: 22512928 DOI: 10.1016/j.addr.2012.03.014] [Citation(s) in RCA: 173] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 03/26/2012] [Accepted: 03/26/2012] [Indexed: 12/11/2022]
Abstract
Over the past several decades, recombinant human bone morphogenetic proteins (rhBMPs) have been the most extensively studied and widely used osteoinductive agents for clinical bone repair. Since rhBMP-2 and rhBMP-7 were cleared by the U.S. Food and Drug Administration for certain clinical uses, millions of patients worldwide have been treated with rhBMPs for various musculoskeletal disorders. Current clinical applications include treatment of long bone fracture non-unions, spinal surgeries, and oral maxillofacial surgeries. Considering the growing number of recent publications related to clincal research of rhBMPs, there exists enormous promise for these proteins to be used in bone regenerative medicine. The authors take this opportunity to review the rhBMP literature paying specific attention to the current applications of rhBMPs in bone repair and spine surgery. The prospective future of rhBMPs delivered in combination with tissue engineered scaffolds is also reviewed.
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