Info

OrthoBlast™

No ++

+

No

10 cm3: USD 850/

DynaGraft®

No ++

+

No

5 cm3 USD 470

ProOsteon® 500R

? + +

No

No

10 cm3: USD 850/

Grafton®

No ++

+

No

5 cm3 USD 470

OSTEOSET®

No ++

No

No

10cm3: USD 1,150

AlloMatrix™

No ++

+

No

6 strips: USD 1,109/

Collagraft™

No ++

+

No

3 strips: USD 683

Vitoss

No ++

No

No

10 cm3: USD 525

Friedlaender et al. [15] evaluated rhOP-1 (BMP-7), comparing clinical and radiographic results in the treatment of tibial nonunion in a controlled, prospective, randomized, and partially blinded clinical trial. They inserted intramedullary rods packed with either rhOP-1 in a type I collagen carrier or with fresh bone autograft. They determined there were no statistically significant differences in the results at 9 months, with 81 and 85% clinical success (respective) and 75 and 84% radiographic success (respective). Interestingly, postoperative osteomyelitis rates at the nonunion site were greater in the autograft group (21% in autograft patients, 3% in OP-1 patients).

Other Issues

Different anatomical sites may require different substitutes. Special consideration must be given to variables of the involved kinetics with different locations, the effects of medications, the impact of disease processes, and of aging on the efficacy of function [2, 3, 6].

Objective measures determining utility of any bone-stabilizing product must certainly include cost containment issues centered around operating room functions, including time required for the procedure, duration of needed anesthesia, supplies used/needed, and length of stay in recovery and in hospital (table 4).

As always, success of fusion depends on many factors, but is maximized by the basic tenets of properly prepared sites, exposed cancellous bone, mechanical loading and stability.

References

1 Heini PF, Berlemann U: Bone substitutes in vertebroplasty. Eur Spine J 2001;10:S205-S213.

2 Greenwald AS, Boden SD, Goldberg VM, Khan Y, Laurencin CT, Rosier RN, for the Committee on Biological Implants: Bone-graft substitutes: Facts, fictions, and applications. J Bone Joint Surg Am 2001;83:S98-S103.

3 Li RH, Wozney JM: Delivering on the promise of bone morphogenetic proteins. Trends Biotechnol 2001;19:255-265.

4 Jackson DW, Scheer MJ, Simon TM: Cartilage substitutes: Overview of basic science and treatment options. J Am Acad Orthop Surg 2001;9/1:37-52.

5 Saito N, Okada T, Horiuchi H, Murakami N, Takahashi J, Nawata M, Ota H, Nozaki K, Takaoka K: A biodegradable polymer as a cytokine delivery system for inducing bone formation. Nat Biotechnol 2001;19:332-335.

6 Kim HD, Valenti RF: Retention and activity of BMP-2 in hyaluronic acid-based scaffolds in vitro. J Biomed Mater Res 2002;59:573-584.

7 Van Dijk M, Smit TH, Sugihara S, Burger EH, Wuisman PI: The effect of cage stiffness on the rate of lumbar interbody fusion. Spine 2002;27:682-688.

8 Sandhu HS: Anterior lumbar interbody fusion with osteoinductive growth factors. Clin Orthop 2000;371:56-60.

9 Boden SD, Hair GA, Viggeswarapu M, Liu Y, Titus L: Gene therapy for spine fusion. Clin Orthop 2000;379S:S225-S233.

10 Oakes DA, Lieberman JR: Osteoinductive applications of regional gene therapy: Ex vivo gene transfer. Clin Orthop 2000;379S:S101-S112.

11 Majumdar MK, Wang E, Morris EA: BMP-2 and BMP-9 promote chondrogenic differentiation of human multipotential mesenchymal cells and overcome the inhibitory effects of IL-1. J Cell Physiol 2001;189:275-284.

12 Kingsley DM: What do BMPs do in mammals? Clues from the mouse short-ear mutation. Trends Genet 1994;10:16-21.

13 Akiyama H, Shukunami C, Nakamura T, Hiraki Y: Differential expressions of BMP family genes during chondrogenic differentiation in mouse ATDC5 cells. Cell Struct Funct 2000;25:195-204.

14 Olmsted EA, Blum JS, Rill D, Yotnda P, Gugala Z, Lindsey RW, Davis AR: Adenovirus-mediated BMP2 expression in human bone marrow stromal cells. J Cell Biochem 2001;82:11-21.

15 Friedlaender GE, Perry CR, Cole JD, Cook SD, Cierny G, Muschler GF, Zych GA, Calhoun JH, LaForte AJ, Yin S: Osteogenic protein-1 (bone morphogenetic protein-7) in the treatment of tibial nonunions. J Bone Joint Surg Am 2001;83:S151-S158.

16 Noshi T, Yoshikawa T, Dohi Y, Ikeuchi M, Horiuchi K, Ichijima K, Sugimura M, Yonemasu K, Ohgushi H: Recombinant human bone morphogenetic-2 potentiates the in vivo osteogenic ability of marrow/hydroxyapatite composites. Artif Organs 2001;25:201-208.

17 Boskey AL, Paschalis EP, Binderman I, Doty SB: BMP-6 accelerates both chondrogenesis and mineral maturation in differentiating chick limb-bud mesenchymal cell cultures. J Cell Biochem 2002;84:509-519.

18 Urist MR: Bone: Formation by autoinduction. Science 1965;150:893-899.

19 Wang EA, Rosen V Cordes P, Hewick RM, Kriz MF, Luxenberg DP, Sibley BS, Wozney JM: Purification and characterization of other distinct bone-inducing factors. Proc Natl Acad Sci USA 1988;85:9484-9488.

20 Boden SD, Zdeblick TA, Sandhu HS, Heim SE: The use of rhBMP-2 in interbody fusion cages: Definitive evidence of osteoinduction in humans: A preliminary report. Spine 2000;25: 376-381.

21 Subach BR, Haid RW, Rodts GE, Kaiser MG: Bone morphogenetic protein in spinal fusion: Overview and clinical update. Neurosurg Focus 2001;10/4:1-6.

22 Sanders EJ, Parker E: Ablation of axial structures activates apoptotic pathways in somite cells of the chick embryo. Anat Embryol 2001;204:389-398.

23 Miller AF, Harvey SA, Thies RS, Olson MS: Bone morphogenetic protein-9. An autocrine/ paracrine cytokine in the liver. J Biol Chem 2000;275:17937-17945.

24 Lopez-Coviella I, Berse B, Krauss R, Thies RS, Blusztajn JK: Induction and maintenance of the neuronal cholinergic phenotype in the CNS by BMP-9. Science 2000;289:313-316.

25 Jordan J, Bottner M, Schluesener HJ, Unsicker K, Krieglstein K: Bone morphogenetic proteins: Neurotrophic roles for midbrain dopaminergic neurons and implications of astroglial cells. Eur J Neurosci 1997;9:1699-1709.

26 De Caestecker M, Meyrick B: Bone morphogenetic proteins, genetics, and the pathophysiology of primary pulmonary hypertension. Respir Res 2001;2/4:193-197.

27 Murata M, Maki F, Sato D, Shibata T, Arisue M: Bone augmentation by onlay implant using recombinant human BMP-2 and collagen on adult rat skull without periosteum. Clin Oral Impl Res 2000;11:289-295.

28 Ripamonti U, van den Heever B, Sampath TK, Tucker MM, Rueger DC, Redoli AH: Complete regeneration of bone in the baboon by recombinant human osteogenic protein-1 (hOP-1, bone morphogenetic protein-7). Growth Factors 1996;13:273-289.

29 Boden SD: Biology of lumbar spine fusion and use of bone graft substitutes: Present, future, and next generation. Tissue Eng 2000;6:383-399.

30 Majumdar MK, Banks V Peluso DP, Morris EA: Isolation, characterization, and chondrogenic potential of human bone marrow-derived multipotential stromal cells. J Cell Physiol 2000;185: 98-106.

Gregory R. Trost, MD

Department of Neurological Surgery

University of Wisconsin-Madison

600 Highland Ave, Madison, WI 53792-3232 (USA)

Tel. +1 608 263 1410, E-Mail [email protected]

Haid RW Jr, Subach BR, Rodts GE Jr (eds): Advances in Spinal Stabilization. Prog Neurol Surg. Basel, Karger, 2003, vol 16, pp 39-54

Was this article helpful?

0 0
Back Pain Revealed

Back Pain Revealed

Tired Having Back Pains All The Time, But You Choose To Ignore It? Every year millions of people see their lives and favorite activities limited by back pain. They forego activities they once loved because of it and in some cases may not even be able to perform their job as well as they once could due to back pain.

Get My Free Ebook


Post a comment