Demineralized Bone Matrix and Fibers in Spinal Fusion

Joshua L. Wang; Ryan G. Eaton; Markus E. Harrigan; Vikas Munjal; Katelyn N. Sette; Seth B. Wilson; Andrew J. Grossbach

doi:10.14444/8558

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Table 1

Review of studies comparing DBM to other bone grafts or implants in cervical spine.

Study	Design	Patient Population	Groups (No. of Patients)	Follow-Up, mo	Fusion Rates	Other Outcomes	Notes
Yi et al, 201537	Prospective and randomized	ACDF	PEEK and HA-DBM (43) vs HA-BTP (42)	12	87% HA-DBM vs 72% HA-BTP (P = 0.16)	No difference in neck disability score or infection	Bonion
Xie et al, 201538	Prospective and randomized	ACDF	PEEK and calcium sulfate and DBM (35) vs autologous ICBG (33)	24	94% DBM vs 100% ICBG (P not reported)		OsteoSet2 DBM
An et al, 199535	Prospective	Uninstrumented anterior cervical fusion	DBM with freeze- dried allograft (39) vs autologous ICBG (38)	12		Higher rates of pseudoarthrosis with DBM/allograft and higher rates of graft collapse	Grafton DBM Gel
Lee et al, 201936	Retrospective	Instrumented ACDF	DBM (24) vs autologous ICBG (17)	24	94% DBM vs 96% ICBG (P = 0.66)		Orthoblast II

Abbreviations: ACDF, anterior cervical discectomy and fusion; BTP, β-tricalcium phosphate; DBM, demineralized bone matrix; HA, hydroxyapatite; ICBG, iliac crest bone graft; PEEK, polyetheretherketone.

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Table 2

Review of studies comparing DBM to other bone grafts or implants in thoracolumbar spine.

Study	Design	Patient Population	Groups (No. of Patients)	Follow-Up, mo	Fusion Rates	Other Outcomes	Notes
Kang et al, 201240	Prospective and randomized	Single-level posterolateral fusion	DBM (30) vs autologous ICBG (16)	24	86% DBM vs 92% ICBG (P > 0.99)	No difference in ODI or physical functioning scores; increased operative blood loss with ICBG (P < 0.0031).	Grafton DBM matrix
Schizas et al, 200842	Prospective	Posterolateral fusion	DBM (33) vs ICBG or LA (26)	12	70% DBM vs 77% autograft (P = 0.77)	No difference in ODI	Accell Connexus
Vaccaro et al, 200743	Prospective	Posterolateral fusion	DBM with bone marrow (19) vs DBM with ICBG (27 patients) vs ICBG (27 patients)	24	63% DBM-bone marrow vs 70% DBM-ICBG vs 67% ICBG (P = 0.88)		Grafton DBM
Cammisa et al, 200444	Prospective intrapatient control	Posterolateral fusion	120 patients in total, DBM on one side, ICBG on the other	24	52% DBM vs 54% ICBG		Grafton DBM
Sassard et al, 200045	Prospective case control	Posterolateral fusion	DBM (56) vs autologous ICBG (52)	24	60% DBM vs 56% ICBG (P = 0.83)	15 ICBG patients reported donor site pain	Grafton DBM
Ricart et al, 201846	Retrospective	Posterolateral fusion	DBM (21) vs BTP (20)	12	90% DBM vs 70% BTP (P = 0.09)	No difference in revision rates or visual analog scores	Grafton DBM
Fu et al, 201641	Retrospective consecutive	Posterolateral fusion >3 levels	DBM (26) vs autologous ICBG (21)		81% DBM vs 86% ICBG (P = 0.72)	Increased operative blood loss with ICBG (P = 0.02)	Allomatrix DBM putty
Nam & Yi, 201647	Retrospective consecutive	Posterolateral fusion	DBM (38) vs HA (41)	12	73% DBM vs 58% HA (P = 0.15)	No difference in ODI or infection	Bonfuse DBM
Baumann et al, 201548	Retrospective	Thoracolumbar fractures	DBM (16) vs autologous ICBG (46)		94% DBM vs 100% ICBG (P = 0.26)		Synthes DBM
Thalgott et al, 200149	Retrospective	Posterolateral fusion	DBM (28) vs LA (12)		92.5% DBM vs 100% LA (P not reported)		Grafton DBM with coralline HA
Interbody Fusions
Ko et al, 202250	Retrospective	Single-level PLIF	DBM (20) vs LA (20)	12	Brantigan-Steffee score 4.4 DBM vs 3.7 LA (P = 0.001)	No difference in ODI	SurFuse
Kim et al, 201651	Retrospective	ALIF, PLIF, and TLIF	HA-DBM (65) vs LA (65)	12	52% HA-DBM vs 62% LA (P = 0.21)	Improvement in ODI in both groups when fusion was achieved; lower rates of fusion with older age and decreased bone mineral density	Bonfuse HA-DBM
Ahn et al, 201452	Retrospective	PLIF	DBM (44) vs LA (70)	24	Not reported	No difference in degree of bone formation or ODI	Allomatrix DBM

Abbreviations: ALIF, anterior lumbar interbody fusion; BTP, β-tricalcium phosphate; DBM, demineralized bone matrix; HA, hydroxyapatite; ICBG, iliac crest bone graft; LA, local autograft; ODI, Oswestry Disability Index; PLIF, posterior lumbar interbody fusion; TLIF, transforaminal lumbar interbody fusion.