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Rudisill KE, Ratnasamy PP, Maloy GC, Grauer JN. Decline in Separate Incision Autograft for Spine Surgery Over the Past Decade: A Fading "gold standard". J Am Acad Orthop Surg 2023; 31:938-944. [PMID: 37332184 DOI: 10.5435/jaaos-d-22-01029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 05/03/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND Spinal fusion is a common procedure for which bone grafting is a critical component. Although iliac crest (separate incision autograft) is typically referred to as the "gold standard" grafting material, it seems to be used less and less frequently. METHODS The 2010 to Q3 2020 MSpine PearlDiver data set was used to identify patients receiving separate incision autograft versus local autograft/allograft/graft supplement for spinal fusion. Grafting trends over the decade were determined. Patient age, sex, Elixhauser Comorbidity Index, smoking status, insurance plan, region of the country where the surgery was conducted, and surgeon specialty were characterized and compared by the type of bone graft using univariate and multivariate analyses. RESULTS Of 373,569 spinal bone grafting procedures, separate incision autografts were used for 32,401 (8.67%). A gradual decline was observed from 2010 (10.57% of spinal grafting procedures) to 2020 (4.69%, P -value < 0.00001). Independent predictors of having had a separate incision autograft in order of decreasing odds included surgeon specialty (relative to neurosurgery, orthopaedic odds ratio [OR], 2.45), smoking status (relative to nonsmokers, smokers OR, 1.45), region of the country (relative to Midwest, Northeast OR, 1.11; West OR, 1.42; and South OR, 1.48), insurance (relative to commercial, Medicare OR, 1.14), younger age (OR, 1.04 per decade increase), and lower Elixhauser Comorbidity Index (OR, 0.95 per two-point increase) ( P < 0.0001 for each). CONCLUSION Iliac crest autograft continues to be referred to as the gold standard grafting material for spine fusions. However, the use of this has faded over the past decade to only 4.69% of spinal fusions in 2020. While some patient factors had an effect on when separate incision autograft was used, nonsurgical factors, including surgeon specialty, geographic region where the surgery was conducted, and insurance factors, suggested that external factors/physician training influence this choice.
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Affiliation(s)
- Katelyn E Rudisill
- From the Department of Orthopedics and Rehabilitation, Yale School of Medicine, New Haven, CT
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Deng Z, Hu B, Yang X, Wang L, Song Y. The improved bioactive n-HA/PA66 cage versus the PEEK cage in anterior cervical fusion: results from a 6-year follow-up and a case-matched study. BMC Musculoskelet Disord 2022; 23:1113. [PMID: 36544134 PMCID: PMC9768934 DOI: 10.1186/s12891-022-06081-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The nanohydroxyapatite/polyamide 66 (n-HA/PA66) cage, a bioactive nonmetal cage, is fabricated in a hollow cylindrical shape and has been widely used for decades with good clinical outcomes for anterior cervical fusion. However, there remain some radiological complications, such as a slightly high subsidence rate. To improve the clinical outcomes, the improved n-HA/PA66 cage now has been developed into a trapezoidal and wedge shape, a better biomechanical shape matching the cervical spine that is similar to that of the PEEK cage. However, there have been no long-term comparisons of the improved n-HA/PA66 cage and PEEK cage in anterior cervical reconstruction. METHODS Fifty-eight patients who underwent single-level anterior cervical decompression and fusion (ACDF) with the improved n-HA/PA66 cage (n-HA/PA66 group) were matched with patients with the PEEK cage (PEEK group) by clinical presentation, segment, age and sex. All patients underwent a minimum of 6 years of follow-up. The radiographic parameters (cage subsidence, fusion status, cervical lordosis, and segmental sagittal alignment) and clinical parameters (10-point visual analogue scale, Neck Disability Index and Japanese Orthopedic Association scores) from patients were evaluated before surgery, immediately after surgery, and at the latest follow-up. RESULTS The n-HA/PA66 and PEEK groups were well matched in terms of clinical presentation, segment, age, and sex at surgery. The n-HA/PA66 and PEEK cages had similar fusion rates at 6 months postoperatively (n-HA/PA66: 58.6% vs. PEEK: 51.7%, P = 0.455) and at the last follow-up (n-HA/PA66: 96.6% vs. PEEK: 93.1%, P = 0.402). The respective cage subsidence rates in the n-HA/PA66 and PEEK groups were 6.9 and 12.1% (P = 0.342). The correction of SA was similar between the groups at the final follow-up (n-HA/PA66: 4.29 ± 1.99 vs. PEEK: 3.99 ± 2.59 P = 0.464). There were no significant differences between the two groups in mean cervical lordosis, visual analogue scale scores of the neck and arm, NDI scores, JOA scores or patients' overall satisfaction at the final follow-up. CONCLUSION After single-level ACDF, the improved n-HA/PA66 cage had similar excellent results in both radiological and clinical outcomes compared with the PEEK cage over 6 years of follow-up. According to these results, the improved n-HA/PA66 cage and the PEEK cage could be comparable for ACDF.
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Affiliation(s)
- Zhipeng Deng
- grid.412901.f0000 0004 1770 1022Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041 Sichuan China
| | - Bowen Hu
- grid.412901.f0000 0004 1770 1022Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041 Sichuan China
| | - Xi Yang
- grid.412901.f0000 0004 1770 1022Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041 Sichuan China
| | - Lei Wang
- grid.412901.f0000 0004 1770 1022Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041 Sichuan China
| | - Yueming Song
- grid.412901.f0000 0004 1770 1022Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041 Sichuan China
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Conway JC, Oliver RA, Wang T, Wills DJ, Herbert J, Buckland T, Walsh WR, Gibson IR. The efficacy of a nanosynthetic bone graft substitute as a bone graft extender in rabbit posterolateral fusion. Spine J 2021; 21:1925-1937. [PMID: 34033931 DOI: 10.1016/j.spinee.2021.05.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/20/2021] [Accepted: 05/19/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Synthetic bone graft substitutes are commonly used in spinal fusion surgery. Preclinical data in a model of spinal fusion to support their efficacy is an important component in clinical adoption to understand how these materials provide a biological and mechanical role in spinal fusion. PURPOSE To evaluate the in vivo response of a nanosynthetic silicated calcium phosphate putty (OstP) combined with autograft compared to autograft alone or a collagen-biphasic calcium phosphate putty (MasP) combined with autograft in a rabbit spinal fusion model. STUDY DESIGN Efficacy of a nanosynthetic silicated calcium phosphate putty as an extender to autograft was studied in an experimental animal model of posterolateral spinal fusion at 6, 9, 12 and 26 weeks, compared to a predicate device. METHODS Skeletally mature female New Zealand White rabbits (70) underwent single level bilateral posterolateral intertransverse process lumbar fusion, using either autograft alone (AG), a nanosynthetic silicated calcium phosphate putty (OstP) combined with autograft (1:1), or a collagen-biphasic calcium phosphate putty (MasP) combined with autograft (1:1). Iliac crest autograft was harvested for each group, and a total of 2 cc of graft material was implanted in the posterolateral gutters per side. Fusion success was assessed at all time points by manual palpation, radiographic assessment, micro-CT and at 12 weeks only using non-destructive range of motion testing. Tissue response, bone formation and graft resorption were assessed by decalcified paraffin histology and by histomorphometry of PMMA embedded sections. RESULTS Assessment of fusion by manual palpation at the 12 week endpoint showed 7 out of 8 (87.5%) bilateral fusions in the OstP extender group, 4 out of 8 (50%) fusions in the MasP extender group, and 6 out of 8 (75%) fusions in the autograft alone group. Similar trends were observed with fusion scores of radiographic and micro-CT data. Histology showed a normal healing response in all groups, and increased bone formation in the OstP extender group at all timepoints compared to the MasP extender group. New bone formed directly on the OstP granule surface within the fusion mass while this was not a feature of the Collagen-Biphasic CaP material. After 26 weeks the OstP extender group exhibited 100% fusions (5 out of 5) by all measures, whereas the MasP extender group resulted in bilateral fusions in 3 out of 5 (60%), assessed by manual palpation, and fusion of only 20 and 0% by radiograph and micro-CT scoring, respectively. Histology at 26 weeks showed consistent bridging of bone between the transverse processes in the Ost P extender group, but this was not observed in the MasP extender group. CONCLUSIONS The nanosynthetic bone graft substituted studied here, used as an extender to autograft, showed a progression to fusion between 6 and 12 weeks that was similar to that observed with autograft alone, and showed excellent fusion outcomes, bone formation and graft resorption at 26 weeks. CLINICAL SIGNIFICANCE This preclinical study showed that the novel nanosynthetic silicated CaP putty, when combined with autograft, achieved equivalent fusion outcomes to autograft. The development of synthetic bone grafts that demonstrate efficacy in such models can eliminate the need for excessive autograft harvest and results from this preclinical study supports their effective use in spinal fusion surgery.
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Affiliation(s)
- Jordan C Conway
- Sirakoss Ltd., Polwarth Building, Foresterhill, Aberdeen, Scotland, AB25 2ZD, UK
| | - Rema A Oliver
- Surgical and Orthopedic Research Laboratories, Prince of Wales Clinical School, UNSW Sydney, Level 1, Clinical Sciences Building, Gate 6, Avoca St, Randwick, Sydney, NSW 2031, Australia
| | - Tian Wang
- Surgical and Orthopedic Research Laboratories, Prince of Wales Clinical School, UNSW Sydney, Level 1, Clinical Sciences Building, Gate 6, Avoca St, Randwick, Sydney, NSW 2031, Australia
| | - Daniel J Wills
- Surgical and Orthopedic Research Laboratories, Prince of Wales Clinical School, UNSW Sydney, Level 1, Clinical Sciences Building, Gate 6, Avoca St, Randwick, Sydney, NSW 2031, Australia
| | - Joe Herbert
- Surgical and Orthopedic Research Laboratories, Prince of Wales Clinical School, UNSW Sydney, Level 1, Clinical Sciences Building, Gate 6, Avoca St, Randwick, Sydney, NSW 2031, Australia
| | - Tom Buckland
- Sirakoss Ltd., Polwarth Building, Foresterhill, Aberdeen, Scotland, AB25 2ZD, UK
| | - William R Walsh
- Surgical and Orthopedic Research Laboratories, Prince of Wales Clinical School, UNSW Sydney, Level 1, Clinical Sciences Building, Gate 6, Avoca St, Randwick, Sydney, NSW 2031, Australia
| | - Iain R Gibson
- Sirakoss Ltd., Polwarth Building, Foresterhill, Aberdeen, Scotland, AB25 2ZD, UK; Institute of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen, Scotland, AB25 2ZD, UK.
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Miar S, Pearson J, Montelongo S, Zamilpa R, Betancourt AM, Ram B, Navara C, Appleford MR, Ong JL, Griffey S, Guda T. Regeneration enhanced in critical-sized bone defects using bone-specific extracellular matrix protein. J Biomed Mater Res B Appl Biomater 2021; 109:538-547. [PMID: 32915522 PMCID: PMC8740960 DOI: 10.1002/jbm.b.34722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 12/19/2022]
Abstract
Extracellular matrix (ECM) products have the potential to improve cellular attachment and promote tissue-specific development by mimicking the native cellular niche. In this study, the therapeutic efficacy of an ECM substratum produced by bone marrow stem cells (BM-MSCs) to promote bone regeneration in vitro and in vivo were evaluated. Fluorescence-activated cell sorting analysis and phenotypic expression were employed to characterize the in vitro BM-MSC response to bone marrow specific ECM (BM-ECM). BM-ECM encouraged cell proliferation and stemness maintenance. The efficacy of BM-ECM as an adjuvant in promoting bone regeneration was evaluated in an orthotopic, segmental critical-sized bone defect in the rat femur over 8 weeks. The groups evaluated were either untreated (negative control); packed with calcium phosphate granules or granules+BM-ECM free protein and stabilized by collagenous membrane. Bone regeneration in vivo was analyzed using microcomputed tomography and histology. in vivo results demonstrated improvements in mineralization, osteogenesis, and tissue infiltration (114 ± 15% increase) in the BM-ECM complex group from 4 to 8 weeks compared to mineral granules only (45 ± 21% increase). Histological observations suggested direct apposition of early bone after 4 weeks and mineral consolidation after 8 weeks implantation for the group supplemented with BM-ECM. Significant osteoid formation and greater functional bone formation (polar moment of inertia was 71 ± 0.2 mm4 with BM-ECM supplementation compared to 48 ± 0.2 mm4 in untreated defects) validated in vivo indicated support of osteoconductivity and increased defect site cellularity. In conclusion, these results suggest that BM-ECM free protein is potentially a therapeutic supplement for stemness maintenance and sustaining osteogenesis.
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Affiliation(s)
- Solaleh Miar
- Department of Biomedical Engineering and Chemical Engineering, University of Texas at San Antonio, San Antonio, Texas
| | - Joseph Pearson
- Department of Biomedical Engineering and Chemical Engineering, University of Texas at San Antonio, San Antonio, Texas
| | - Sergio Montelongo
- Department of Biomedical Engineering and Chemical Engineering, University of Texas at San Antonio, San Antonio, Texas
| | - Rogelio Zamilpa
- StemBioSys Inc., San Antonio, Texas
- GenCure Inc., San Antonio, Texas
| | - Alejandro M. Betancourt
- Department of Biomedical Engineering and Chemical Engineering, University of Texas at San Antonio, San Antonio, Texas
| | - Bharath Ram
- Department of Biomedical Engineering and Chemical Engineering, University of Texas at San Antonio, San Antonio, Texas
- Department of Biology, University of Texas at San Antonio, San Antonio, Texas
| | - Christopher Navara
- Department of Biology, University of Texas at San Antonio, San Antonio, Texas
| | - Mark R. Appleford
- Department of Biomedical Engineering and Chemical Engineering, University of Texas at San Antonio, San Antonio, Texas
| | - Joo L. Ong
- Department of Biomedical Engineering and Chemical Engineering, University of Texas at San Antonio, San Antonio, Texas
| | | | - Teja Guda
- Department of Biomedical Engineering and Chemical Engineering, University of Texas at San Antonio, San Antonio, Texas
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Smith KA, Russo GS, Vaccaro AR, Arnold PM. Scientific, Clinical, Regulatory, and Economic Aspects of Choosing Bone Graft/Biological Options in Spine Surgery. Neurosurgery 2020; 84:827-835. [PMID: 30032187 DOI: 10.1093/neuros/nyy322] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/17/2018] [Indexed: 01/07/2023] Open
Abstract
Spinal arthrodesis is a major element of the spinal surgeon's practice. To attain successful fusion rates, attention must be paid to spinal segment immobilization and proper selection of bone graft. Autogenous bone graft (ie, ICBG), the "gold standard," with or without graft extenders and enhancers provides the foundation for most spinal fusions. ABG is the only graft option containing all 3 factors of new bone growth: osteoconductivity, osteoinductivity, and osteogenicity. While many bone graft alternatives function well as bone graft extenders, only growth factors proteins (ie, rhBMP-2 or OP-2) function as bone graft enhancers and substitutes. The search for optimal hybrid interbody cages, bone graft substitutes, autogenous or allogenic stem cells, and nanostructure scaffolds for release of growth factors continues.
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Affiliation(s)
- Kyle A Smith
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Glenn S Russo
- Department of Orthopedics, Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Alexander R Vaccaro
- Department of Orthopedics, Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Paul M Arnold
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas
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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: 17] [Impact Index Per Article: 3.4] [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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van Dijk LA, Barbieri D, Barrère‐de Groot F, Yuan H, Oliver R, Christou C, Walsh WR, de Bruijn JD. Efficacy of a synthetic calcium phosphate with submicron surface topography as autograft extender in lapine posterolateral spinal fusion. J Biomed Mater Res B Appl Biomater 2019; 107:2080-2090. [PMID: 30614621 PMCID: PMC6690075 DOI: 10.1002/jbm.b.34301] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/18/2018] [Accepted: 12/01/2018] [Indexed: 12/19/2022]
Abstract
Posterolateral spinal fusion (PLF) is a common procedure in orthopedic surgery that is performed to fuse adjacent vertebrae to reduce symptoms related to spinal conditions. In the current study, a novel synthetic calcium phosphate with submicron surface topography was evaluated as an autograft extender in a validated rabbit model of PLF. Fifty-nine skeletally mature New Zealand white rabbits were divided into three groups and underwent single-level intertransverse process PLF at L4-5 using (1) autologous bone graft (ABG) alone or in a 1:1 combination with (2) calcium phosphate granules (ABG/BCPgranules ), or (3) granules embedded in a fast-resorbing polymeric carrier (ABG/BCPputty ). After 6, 9, and 12 weeks, animals were sacrificed and spinal fusion was assessed by manual palpation, Radiographs, micro-CT, mechanical testing (12 weeks only), histology, and histomorphometry. Based on all endpoints, all groups showed a gradual progression in bone formation and maturation during time, leading to solid fusion masses between the transverse processes after 12 weeks. Fusion assessments by manual palpation, radiography and histology were consistent and demonstrated equivalent fusion rates between groups, with high bilateral fusion rates after 12 weeks. Mechanical tests after 12 weeks indicated substantially lower range of motion for all groups, compared to non-operated controls. By histology and histomorphometry, the gradual formation and maturation of bone in the fusion mass was confirmed for each graft type. With these results, we describe the equivalent performance between autograft and a novel calcium phosphate material as an autograft extender in a rabbit model of PLF using an extensive range of evaluation techniques. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 2080-2090, 2019.
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Affiliation(s)
- Lukas A. van Dijk
- Kuros Biosciences BVBilthoventhe Netherlands
- Department of Oral and Maxillofacial Surgery, University Medical Center UtrechtUtrechtthe Netherlands
| | | | | | - Huipin Yuan
- Kuros Biosciences BVBilthoventhe Netherlands
- Complex Tissue Regeneration, MERLN Institute, Maastricht UniversityMaastrichtthe Netherlands
| | - Rema Oliver
- Surgical and Orthopedic Research LaboratoriesUniversity of New South WalesSydneyNew South WalesAustralia
| | - Chris Christou
- Surgical and Orthopedic Research LaboratoriesUniversity of New South WalesSydneyNew South WalesAustralia
| | - William R. Walsh
- Surgical and Orthopedic Research LaboratoriesUniversity of New South WalesSydneyNew South WalesAustralia
| | - Joost D. de Bruijn
- Kuros Biosciences BVBilthoventhe Netherlands
- School of Engineering and Materials Science, Queen Mary University of LondonLondonUK
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Yunus Basha R, Sampath Kumar TS, Doble M. Design of biocomposite materials for bone tissue regeneration. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2015; 57:452-63. [PMID: 26354284 DOI: 10.1016/j.msec.2015.07.016] [Citation(s) in RCA: 150] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 05/24/2015] [Accepted: 07/09/2015] [Indexed: 02/06/2023]
Abstract
Several synthetic scaffolds are being developed using polymers, ceramics and their composites to overcome the limitations of auto- and allografts. Polymer-ceramic composites appear to be the most promising bone graft substitute since the natural bone itself is a composite of collagen and hydroxyapatite. Ceramics provide strength and osteoconductivity to the scaffold while polymers impart flexibility and resorbability. Natural polymers have an edge over synthetic polymers because of their biocompatibility and biological recognition property. But, very few natural polymer-ceramic composites are available as commercial products, and those few are predominantly based on type I collagen. Disadvantages of using collagen include allergic reactions and pathogen transmission. The commercial products also lack sufficient mechanical properties. This review summarizes the recent developments of biocomposite materials as bone scaffolds to overcome these drawbacks. Their characteristics, in vitro and in vivo performance are discussed with emphasis on their mechanical properties and ways to improve their performance.
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Affiliation(s)
- Rubaiya Yunus Basha
- Department of Biotechnology, Indian Institute of Technology Madras, Chennai 600036, India
| | - T S Sampath Kumar
- Department of Metallurgical and Materials Engineering, Indian Institute of Technology Madras, Chennai 600036, India
| | - Mukesh Doble
- Department of Biotechnology, Indian Institute of Technology Madras, Chennai 600036, India.
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Smith BD, Grande DA. The current state of scaffolds for musculoskeletal regenerative applications. Nat Rev Rheumatol 2015; 11:213-22. [DOI: 10.1038/nrrheum.2015.27] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Ghodasra JH, Daley EL, Hsu EL, Hsu WK. Factors influencing arthrodesis rates in a rabbit posterolateral spine model with iliac crest autograft. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 23:426-34. [PMID: 24166021 DOI: 10.1007/s00586-013-3074-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 10/12/2013] [Accepted: 10/13/2013] [Indexed: 12/01/2022]
Abstract
PURPOSE The rabbit posterolateral intertransverse spine arthrodesis model has been widely used to evaluate spinal biologics. However, to date, the validity and reproducibility of performance of iliac crest bone graft, the most common and critical control group, has not been firmly established. We evaluated original research publications that utilized this model, identified which experimental conditions affected fusion rates, and developed an algorithm to predict fusion rates for future study designs. METHODS A MEDLINE search was performed for publications through December, 2011 that utilized this model to evaluate fusion rates elicited by iliac crest autograft. All study parameters were recorded, and logistic regression analyses were performed to determine the effects of these variables on fusion rates as determined by either manual palpation or radiographs. RESULTS Seventy studies with 959 rabbits in 102 groups met the inclusion criteria. Excluding studies that measured fusion at 4 or fewer weeks or intentionally tried to decrease the fusion rate, the overall fusion rate for autograft was 58.3 ± 16.3 % (mean ± SD) as determined by manual palpation and 66.4 ± 17.8 % by plain radiographs. Regression analysis demonstrated a difference between these outcome measures with a trend towards significance (p = 0.09). Longer time points and larger volumes of autograft resulted in significantly greater reported fusion rates (p < 0.0001 and p < 0.05, respectively). Neither strain, age, weight, nor vertebral level significantly affected fusion rates. CONCLUSIONS Although experimental conditions varied across studies, time point evaluation and autograft volume significantly affected fusion rates. Despite some variability demonstrated across certain studies, we demonstrated that when the time point and volume of autograft were controlled for, the iliac crest control group of the rabbit posterolateral spinal arthrodesis model is both reliable and predictably affected by different experimental conditions.
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Affiliation(s)
- Jason H Ghodasra
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave., 76-143 CHS, Los Angeles, CA, 90095, USA,
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