Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 16: Bone graft extenders and substitutes as an adjunct for lumbar fusion

Michael G. Kaiser, Michael W. Groff, William C. Watters, Zoher Ghogawala, Praveen V. Mummaneni, Andrew T. Dailey, Tanvir F. Choudhri, Jason C. Eck, Alok Sharan, Jeffrey C. Wang, Sanjay S. Dhall, Daniel K. Resnick

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

In an attempt to enhance the potential to achieve a solid arthrodesis and avoid the morbidity of harvesting autologous iliac crest bone (AICB) for a lumbar fusion, numerous alternatives have been investigated. The use of these fusion adjuncts has become routine despite a lack of convincing evidence demonstrating a benefit to justify added costs or potential harm. Potential alternatives to AICB include locally harvested autograft, calcium-phosphate salts, demineralized bone matrix (DBM), and the family of bone morphogenetic proteins (BMPs). In particular, no option has created greater controversy than the BMPs. A significant increase in the number of publications, particularly with respect to the BMPs, has taken place since the release of the original guidelines. Both DBM and the calciumphosphate salts have demonstrated efficacy as a graft extender or as a substitute for AICB when combined with local autograft. The use of recombinant human BMP-2 (rhBMP-2) as a substitute for AICB, when performing an interbody lumbar fusion, is considered an option since similar outcomes have been observed; however, the potential for heterotopic bone formation is a concern. The use of rhBMP-2, when combined with calcium phosphates, as a substitute for AICB, or as an extender, when used with local autograft or AICB, is also considered an option as similar fusion rates and clinical outcomes have been observed. Surgeons electing to use BMPs should be aware of a growing body of literature demonstrating unique complications associated with the use of BMPs.

Original languageEnglish (US)
Pages (from-to)106-132
Number of pages27
JournalJournal of Neurosurgery: Spine
Volume21
Issue number1
DOIs
StatePublished - 2014

Fingerprint

Bone Morphogenetic Proteins
Spine
Guidelines
Transplants
Bone and Bones
Autografts
Bone Matrix
Salts
Calcium Phosphates
Arthrodesis
Osteogenesis
Publications
Morbidity
Costs and Cost Analysis

Keywords

  • Bone graft
  • Bone morphogenetic protein
  • Bone substitute
  • Fusion
  • Lumbar spine
  • Practice guidelines

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Neurology

Cite this

Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 16 : Bone graft extenders and substitutes as an adjunct for lumbar fusion. / Kaiser, Michael G.; Groff, Michael W.; Watters, William C.; Ghogawala, Zoher; Mummaneni, Praveen V.; Dailey, Andrew T.; Choudhri, Tanvir F.; Eck, Jason C.; Sharan, Alok; Wang, Jeffrey C.; Dhall, Sanjay S.; Resnick, Daniel K.

In: Journal of Neurosurgery: Spine, Vol. 21, No. 1, 2014, p. 106-132.

Research output: Contribution to journalArticle

Kaiser, MG, Groff, MW, Watters, WC, Ghogawala, Z, Mummaneni, PV, Dailey, AT, Choudhri, TF, Eck, JC, Sharan, A, Wang, JC, Dhall, SS & Resnick, DK 2014, 'Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 16: Bone graft extenders and substitutes as an adjunct for lumbar fusion', Journal of Neurosurgery: Spine, vol. 21, no. 1, pp. 106-132. https://doi.org/10.3171/2014.4.SPINE14325
Kaiser, Michael G. ; Groff, Michael W. ; Watters, William C. ; Ghogawala, Zoher ; Mummaneni, Praveen V. ; Dailey, Andrew T. ; Choudhri, Tanvir F. ; Eck, Jason C. ; Sharan, Alok ; Wang, Jeffrey C. ; Dhall, Sanjay S. ; Resnick, Daniel K. / Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 16 : Bone graft extenders and substitutes as an adjunct for lumbar fusion. In: Journal of Neurosurgery: Spine. 2014 ; Vol. 21, No. 1. pp. 106-132.
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