Histological remodelling of demineralised bone matrix allograft in posterolateral fusion of the spine – an ex vivo study

BMC Surgery

Clément ML Werner²  Hans-Peter Simmen²  Guido A Wanner²  Georg Osterhoff²  Brigitte von Rechenberg¹  Samy Bouaicha² 

[1] Musculoskeletal Research Unit, Equine Hospital, Vetsuisse Faculty ZH, University of Zurich, Zurich, Switzerland;Division of Traumatology, University Hospital of Zurich, University of Zurich, Raemistrasse 100, Zurich 8091, Switzerland

关键词: Ex vivo;    Allograft;    Histology;    Demineralised bone matrix;    Spine fusion;   

Others  :  866895
DOI  :  10.1186/1471-2482-13-58

 received in 2013-06-22, accepted in 2013-12-09,  发布年份 2013

【 摘 要 】

Background

Demineralised bone matrix (DBM) has shown to be effective in enhancing posterior fusion of the spine. Several animal studies and clinical investigations in humans showed its successful remodelling. The use of allogenic matrix may decrease the need of autologous bone graft and therefore helps prevent corresponding donor site morbidity. Since DBM products are very expensive, the question arises, whether it is completely remodelled into new bone, and therefore truly is comparable to autologous cancellous bone graft. To our knowledge there is no report of a consecutive series of patients where ex vivo histological analysis after postero-lateral fusion of the spine was performed.

Methods

Osseous biopsies of nine consecutive patients who underwent postero-lateral fusion of the spine for trauma were obtained at the time of elective removal of the hardware. Histological samples were then analyzed on ground and thin sections stained with toluidine blue and von Kossa stainings.

Results

Time span between index operation and removal of the metal ranged between 6 and 18 month. Histological analysis showed good incorporation and overall remodelling of DBM into new bone in all patients. No foreign body reaction was visible and new bone formation progressed time dependently with DBM in situ. Four out of nine patients showed more than 50% new bone formation after one year.

Conclusion

DBM shows good overall remodelling properties in histological analysis and therefore seems to be an effective adjunct in postero-lateral fusion of the spine. Furthermore, DBM substitution increases over time.

【 授权许可】

   
2013 Bouaicha et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Rihn JA, Kirkpatrick K, Albert TJ: Graft options in posterolateral and posterior interbody lumbar fusion. Spine (Phila Pa 1976) 2010, 35(17):1629-1639.
• [2]Brandoff JF, Silber JS, Vaccaro AR: Contemporary alternatives to synthetic bone grafts for spine surgery. Am J Orthop (Belle Mead NJ). 2008, 37(8):410-414.
• [3]Fernyhough JC, Schimandle JJ, Weigel MC, Edwards CC, Levine AM: Chronic donor site pain complicating bone graft harvesting from the posterior iliac crest for spinal fusion. Spine (Phila Pa 1976) 1992, 17(12):1474-1480.
• [4]Kurz LT, Garfin SR, Booth RE Jr: Harvesting autogenous iliac bone grafts. A review of complications and techniques. Spine (Phila Pa 1976) 1989, 14(12):1324-1331.
• [5]Laurie SW, Kaban LB, Mulliken JB, Murray JE: Donor-site morbidity after harvesting rib and iliac bone. Plast Reconstr Surg 1984, 73(6):933-938.
• [6]Russell JL, Block JE: Surgical harvesting of bone graft from the ilium: point of view. Med Hypotheses 2000, 55(6):474-479.
• [7]Summers BN, Eisenstein SM: Donor site pain from the ilium. A complication of lumbar spine fusion. J Bone Joint Surg Br. 1989, 71(4):677-680.
• [8]Younger EM, Chapman MW: Morbidity at bone graft donor sites. J Orthop Trauma 1989, 3(3):192-195.
• [9]Frenkel SR, Moskovich R, Spivak J, Zhang ZH, Prewett AB: Demineralized bone matrix. Enhancement of spinal fusion. Spine (Phila Pa 1976) 1993, 18(12):1634-1639.
• [10]Guizzardi S, Di Silvestre M, Scandroglio R, Ruggeri A, Savini R: Implants of heterologous demineralized bone matrix for induction of posterior spinal fusion in rats. Spine (Phila Pa 1976) 1992, 17(6):701-707.
• [11]Morone MA, Boden SD: Experimental posterolateral lumbar spinal fusion with a demineralized bone matrix gel. Spine (Phila Pa 1976) 1998, 23(2):159-167.
• [12]Oikarinen J: Experimental spinal fusion with decalcified bone matrix and deep-frozen allogeneic bone in rabbits. Clin Orthop Relat Res 1982, 162:210-2018.
• [13]Edwards JT, Diegmann MH, Scarborough NL: Osteoinduction of human demineralized bone: characterization in a rat model. Clin Orthop Relat Res 1998, 357:219-228.
• [14]Lee KJ, Roper JG, Wang JC: Demineralized bone matrix and spinal arthrodesis. Spine J 2005, 5(6 Suppl):217S-223S.
• [15]Sassard WR, Eidman DK, Gray PM, Block JE, Russo R, Russell JL, et al.: Augmenting local bone with Grafton demineralized bone matrix for posterolateral lumbar spine fusion: avoiding second site autologous bone harvest. Orthopedics 2000, 23(10):1059-1064. discussion 64–5
• [16]Girardi FP, Cammisa FP Jr: The effect of bone graft extenders to enhance the performance of iliac crest bone grafts in instrumented lumbar spine fusion. Orthopedics 2003, 26(5 Suppl):s545-s548.
• [17]Cammisa FP Jr, Lowery G, Garfin SR, Geisler FH, Klara PM, McGuire RA, et al.: Two-year fusion rate equivalency between Grafton DBM gel and autograft in posterolateral spine fusion: a prospective controlled trial employing a side-by-side comparison in the same patient. Spine (Phila Pa 1976) 2004, 29(6):660-666.
• [18]Schwartz Z, Goldstein M, Raviv E, Hirsch A, Ranly DM, Boyan BD: Clinical evaluation of demineralized bone allograft in a hyaluronic acid carrier for sinus lift augmentation in humans: a computed tomography and histomorphometric study. Clin Oral Implants Res 2007, 18(2):204-211.
• [19]Betz RR, Lavelle WF, Mulcahey MJ, Samdani AF: Histology of a fusion mass augmented with demineralized bone matrix for congenital scoliosis. J Pediatr Orthop B 2011, 20(1):37-40.
• [20]Engelhardt P, Gasser JA: LEICA HistoDur: a resin specifically designed for the histology of mineralized tissues. In Leica Applications Brief. Switzerland: Sandoz Pharma LTD, Osteoporosis Research, 4002 Basel; 1995.
• [21]Leutenegger CM, von Rechenberg B, Huder JB, Zlinsky K, Mislin C, Akens MK, et al.: Quantitative real-time PCR for equine cytokine mRNA in nondecalcified bone tissue embedded in methyl methacrylate. Calcif Tissue Int 1999, 65(5):378-383.
• [22]Phemister D: The fate of transplanted bone and regenerative power of various constituents. Surg Gynecol Obstet 1914, 19:303-333.