Dr. Elyse Watkins, DHSc, PA-C, DFAAPA
Does the utilization of demineralized bone matrix with cancellous allograft enhance overall bone grafting when incorporated in spondylosyndesis surgery?
Spondylosyndesis is a steadily increasing surgical procedure used to stabilize a variety of spinal abnormalities, requiring successful ossification to achieve a stable and solid fusion. Iliac crest bone grafting (ICBG) has been viewed as the ‘gold standard’ medium through the years for achieving spinal fusion although has been shown to produce adverse effects in overall healing and donor site pain and associated complications. The introduction of cancellous allograft bone alleviates the need for harvesting autograft however allograft in itself does not possess demonstratable osteoconductive potential as does ICBG in addition to producing adverse post-operative negative attributes itself.
Recombinant human bone morphogenic proteins (rhBMPs) are skeletal organogenesis demineralized bone matrix compounds which serve as signaling molecules, inducing osteoblastic differentiation. Osteoblastic differentiation is the primary development for bone fusion in spondylosyndesis surgery. Several studies have revealed positive responses with the introduction of Bone Morphogenic Proteins, but not without risks and concerns. These include unwanted adjacent level fusion, increased wound infection potential with anterior cervical fusions and possible cancer. Although DBM compounds have been shown to increase the efficacy of bone grafting in spondylosyndesis surgery, adverse outcomes with the use of DBM compounds in certain situations reveal the need for continued studies to ascertain the true beneficial effect for their use.
Chisum JD. Does the utilization of Demineralized Bone Matrix with Cancellous Allograft enhance overall bone grafting when incorporated in Spondylosyndesis Surgery?. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2020; 2(2).
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