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J Am Acad Orthop Surg, Vol 13, No 2, March/April 2005, 129-137.
© 2005 the American Academy of Orthopaedic Surgeons
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Use of Osteopromotive Growth Factors, Demineralized Bone Matrix, and Ceramics to Enhance Spinal Fusion

Safdar N. Khan, MD, Justin F. Fraser, Harvinder S. Sandhu, MD, Frank P. Cammisa, Jr, MD, Federico P. Girardi, MD and Joseph M. Lane, MD

Dr. Khan is Resident, Department of Orthopaedic Surgery, University of California at Davis, Sacramento, CA. Mr. Fraser is Medical Student, Weill Medical College of Cornell University, New York, NY. Dr. Sandhu is Associate Professor of Orthopaedic Surgery, Weill Medical College of Cornell University and Director, Spine Surgery Fellowship Program, Hospital for Special Surgery, New York, NY. Dr. Cammisa is Chief, Spinal Surgical Service, and Associate Attending Surgeon, Hospital for Special Surgery, and Associate Professor of Clinical Orthopaedic Surgery, Weill Medical College of Cornell University. Dr. Girardi is Assistant Attending Surgeon, Hospital for Special Surgery. Dr. Lane is Attending Surgeon, Hospital for Special Surgery, Chief, Metabolic Bone Disease Service, and Professor, Department of Orthopedic Surgery, Weill Medical College of Cornell University.

Reprint requests: Dr. Sandhu, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021.

Recently developed materials that can enhance fusion rates for posterolateral lumbar arthrodesis may be used alone or in combination with autogenous bone grafts. Novel osteopromotive growth factor preparations are currently under scrutiny; these include autogenous growth factor concentrate, bovine bone-derived osteoinductive protein, and recombinant human MP52. Demineralized bone matrix products may enhance or extend grafts. However, few studies, especially prospective randomized clinical trials, have assessed their efficacy, so it is difficult to compare formulations. Ceramics have been evaluated in animal studies and human clinical trials for a variety of applications in spinal surgery. These materials function best as bone graft extenders or as bioactive osteoinductive material carriers in posterolateral lumbar fusions. They have the advantage of variable porosity, low cost, and ease of manufacture. Hydroxyapatite/tricalcium phosphate ceramics have been shown to perform as well as autogenous bone grafts but with fewer complications.






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Copyright © 2005 by the American Academy of Orthopaedic Surgeons.