Osteogenic differentiation of bone marrow mesenchymal stem cells induced by demineralized bone matrix in vitro / 中国组织工程研究

BACKGROUND: Demineralized bone matrix contains many kinds of active factors such as bone morphogenetic protein 2, which can promote bone marrow mesenchymal stem cells to transform into chondrocytes and promote their proliferation under specific joint microenvironment. OBJECTIVE: To explore the osteogenic differentiation of bone marrow mesenchymal stem cells in vitro induced by demineralized bone matrix and its research value as cell carrier scaffold in the treatment of bone defect. METHODS: Rat femur bone marrow mesenchymal stem cells were isolated and adhered with whole bone marrow. Bone marrow mesenchymal stem cells at passage 3 were selected and cultured with complete medium and 50 mg/L demineralized bone matrix inducer. The proliferation and viability of bone marrow mesenchymal stem cells were determined by CCK-8 assay. Alkaline phosphatase activities were quantitatively measured by enzyme labeling at 7 and 14 days after culture. Calcium nodule formation was observed by alizarin red staining 21 days after culture. The expression of osteogenesis-related factors was detected by qRT-PCR 21 days after culture. Demineralized bone matrix and bone marrow mesenchymal stem cells were cultured for 21 days. The adhesion of them was observed by ordinary optical inverted phase contrast microscope and scanning electron microscope. RESULTS AND CONCLUSION: (1) The number of cells on days 5 and 6 in the demineralized bone matrix group was higher than that in the complete medium group (P < 0.05). (2) Alkaline phosphatase activities were significantly higher in the demineralized bone matrix group than in the complete medium group at 7 and 14 days (P < 0.05). (3) Calcium nodules were more in the demineralized bone matrix group than in the complete medium group. (4) The expression of RUNX2, ALP, OCN and OPN was significantly higher in the demineralized bone matrix group than in the complete medium group (P < 0.05). (5) The adherence of bone marrow mesenchymal stem cells was good on the demineralized bone matrix; cells were distributed in the space between scaffolds and crawled with each other. (6) The results showed that demineralized bone matrix could induce bone marrow mesenchymal stem cells to differentiate into osteoblasts, and the adhesion was good, which provided theoretical reference for the research of tissue engineering composite materials.

Induction of Chondrogenic Differentiation in Human Mesenchymal Stem Cells Cultured on Human Demineralized Bone Matrix Scaffold under Hydrostatic Pressure

BACKGROUND: Articular cartilage damage is still a troublesome problem. Hence, several researches have been performed for cartilage repair. The aim of this study was to evaluate the chondrogenicity of demineralized bone matrix (DBM) scaffolds under cyclic hydrostatic pressure (CHP) in vitro. METHODS: In this study, CHP was applied to human bone marrow mesenchymal stem cells (hBMSCs) seeded on DBM scaffolds at a pressure of 5 MPa with a frequency of 0.5 Hz and 4 h per day for 1 week. Changes in chondrogenic and osteogenic gene expressions were analyzed by quantifying mRNA signal level of Sox9, collagen type I, collagen type II, aggrecan (ACAN), Osteocalcin, and Runx2. Histological analysis was carried out by hematoxylin and eosin, and Alcian blue staining. Moreover, DMMB and immunofluorescence staining were used for glycosaminoglycan (GAG) and collagen type II detection, respectively. RESULTS: Real-time PCR demonstrated that applying CHP to hBMSCs in DBM scaffolds increased mRNA levels by 1.3-fold, 1.2-fold, and 1.7-fold (p < 0.005) for Sox9, Col2, and ACAN, respectively by day 21, whereas it decreased mRNA levels by 0.7-fold and 0.8-fold (p < 0.05) for Runx2 and osteocalcin, respectively. Additionally, in the presence of TGF-β1 growth factor (10 ng/ml), CHP further increased mRNA levels for the mentioned genes (Sox9, Col2, and ACAN) by 1.4-fold, 1.3-fold and 2.5-fold (p < 0.005), respectively. Furthermore, in histological assessment, it was observed that the extracellular matrix contained GAG and type II collagen in scaffolds under CHP and CHP with TGF-β1, respectively. CONCLUSION: The osteo-inductive DBM scaffolds showed chondrogenic characteristics under hydrostatic pressure. Our study can be a fundamental study for the use of DBM in articular cartilage defects in vivo and lead to production of novel scaffolds with two different characteristics to regenerate both bone and cartilage simultaneously.

Comparison of Cortical Ring Allograft and Plate Fixation with Autologous Iliac Bone Graft for Anterior Cervical Discectomy and Fusion

STUDY DESIGN: A retrospective cohort study. PURPOSE: To compare the clinical and radiological outcomes of patients who underwent anterior cervical discectomy and fusion (ACDF) supplemented with plate fixation using allograft with those who underwent ACDF using tricortical iliac autograft. OVERVIEW OF LITERATURE: As plate fixation is becoming popular, it is reported that ACDF using allograft may have similar outcomes compared with ACDF using autograft. METHODS: Forty-one patients who underwent ACDF supplemented with plate fixation were included in this study. We evaluated 24 patients who used cortical ring allograft filled with demineralized bone matrix (DBM) (group A) and 17 patients who used tricortical iliac autograft (group B). In radiological evaluations, fusion rate, subsidence of grafted material, cervical lordosis, fused segmental lordosis, and radiological adjacent segment degeneration (ASD) were observed and analyzed with preoperative and postoperative plain radiographs. Clinical outcomes were evaluated using the Neck Disability Index score, Odom criteria, and Visual Analog Scale score of neck and upper extremity pain. Radiological union was determined by dynamic radiographs using cutoff values of 1 mm of interspinous motion as the indication of pseudarthrosis. RESULTS: There was no significant difference in the fusion rate, graft subsidence, cervical lordosis, fused segmental lordosis, and ASD incidence between the groups. Operative time was shorter in group A (136 min) than in group B (141 min), but it was not significant (p>0.05). Blood loss was greater in group B (325 mL) than in group A (210 mL, p=0.013). There was no difference in the clinical outcomes before and after surgery. CONCLUSIONS: In ACDF with plate fixation, cortical ring allograft filled with DBM group showed similar radiological and clinical outcomes compared with those of the autograft group. If the metal plate is reinforced, using cortical ring allograft could be a viable alternative to autograft.

Outcomes of Anterior Cervical Fusion Using Polyetheretherketone Cage with Demineralized Bone Matrix and Plate for Management of Subaxial Cervical Spine Injuries / 대한신경손상학회지

OBJECTIVE: We evaluated the usefulness of a polyetheretherketone (PEEK) cage filled with demineralized bone matrix (DBM) and plate fixation in anterior interbody fusions for subaxial cervical spine injuries. METHODS: A retrospective review of 98 patients (58 women, 40 men; mean age, 49.7 years; range, 17–78 years) who underwent single-level anterior cervical discectomy and fusion (ACDF) using a PEEK cage filled with DBM and plate fixation for subaxial cervical spine injuries from March 2005 to June 2018 was conducted. Bone fusion, interbody height (IBH), segmental lordosis, and adjacent segment degeneration (ASD) development were assessed with plain radiographs and computed tomography. Clinical outcomes were assessed using a visual analog scale (VAS) for pain and the Frankel grade for neurologic function. RESULTS: The mean follow-up period was 27.6 months (range, 6–142 months). Twenty-one patients (21.4%) had an improvement of at least one Frankel grade. The mean preoperative and final follow-up neck pain VAS scores were 8.3±0.9 and 2.6±1.5 (p < 0.05). All patients showed solid fusion at the final follow-up. The mean preoperative and final Cobb's angles were −3.7±7.9° and 1.9±5.1° (p < 0.05). The mean preoperative and final IBHs were 36.9±1.7 mm and 38.2±1.8 mm (p < 0.05). Five patients (5%) showed ASD. CONCLUSION: ACDF using a PEEK cage filled with DBM and plate fixation yielded high fusion rates and satisfactory clinical outcomes without donor-site morbidity. This procedure is safe and effective for single-level subaxial cervical spine injuries.

Comparison between Accurate Anatomical Reduction and Unsuccessful Reduction with a Remaining Gap after Open Reduction and Plate Fixation of Midshaft Clavicle Fracture

BACKGROUND: The purpose of this study is to compare the radiological and clinical outcomes after open reduction and plate fixation of midshaft clavicle fractures between patients who achieved successful anatomical reduction and those who had a remaining fracture gap even after open reduction and plate fixation, and were thus treated with additional demineralized bone matrix (DBM). METHODS: This retrospective analysis was conducted on 56 consecutive patients who underwent open reduction and internal fixation using a locking compression plate for acute displaced midshaft clavicle fractures, and who underwent radiographic and clinical outcome evaluations at least 6 months postoperatively. The outcomes between those who achieved perfect anatomical reduction without remnant gap (n=32) and those who had a remaining fracture gap even after open reduction and plate fixation treated with additional DBM (n=24) were evaluated. RESULTS: There were no differences in the use of lag screws or wiring and operation time (all p>0.05) between those with and without remnant gap. No difference in the average radiological union time and clinical outcomes (satisfaction and Constant score) was observed between the two groups (all p>0.05). However, significantly faster union time was observed for AO type A fracture compared with other types (p=0.012), and traffic accident showed association with worse clinical outcomes compared with other causes of injury. CONCLUSIONS: Surgical outcome of midshaft clavicle fracture was more affected by initial fracture type and event, and re-reduction and re-fixation of the fracture to obtain a perfect anatomical reduction spending time appears to be unnecessary if rigid fixation is achieved.

Efficiency and Safety of Demineralized Bone Matrix for Posterolateral Fusion / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to analyze the effects of demineralized bone matrix on posterolateral lumbar fusion. MATERIALS AND METHODS: From 2009 to 2012, 30 patients who had undergone posterolateral fusions using demineralized bone matrix (group I) and 30 who had received autogenous posterior iliac bone grafts (group II) were investigated. Bone union was determined by evaluating serial simple lumbar radiographs taken during the 24 months after surgery. Bone status was classified according to Lenke's scale and the bone fusion was finally determined by flexion/extension lateral radiographs. We also examined halo signs around the pedicular screws evident on the radiographs, scored back pain using a visual analogue scale (VAS), and Oswestry disability index (ODI) score 2 years after surgery to evaluate clinical status of patients. RESULTS: In group I, 19 patients showed union and 11 patients did not; the values for group II were 22 and 8. These proportions did not differ significantly (p=0.57). Time to union was somewhat shorter in group II (25.3±7.9 weeks), but did not differ significantly from that of group I (p=0.097). No statistical significance in the periscrew Halo count, VAS for back pain, and ODI score was observed between the two groups. CONCLUSION: The union rate after using demineralized bone matrix for lumbar posterolateral fusion is similar to that attained when autogenous bone grafts are employed, and lacks the morbidity associated with such grafts. Thus, demineralized bone matrix is an effective bone graft substitute when posterolateral fusion surgery of the lumbar spine is required.

Comparison between Accurate Anatomical Reduction and Unsuccessful Reduction with a Remaining Gap after Open Reduction and Plate Fixation of Midshaft Clavicle Fracture

BACKGROUND: The purpose of this study is to compare the radiological and clinical outcomes after open reduction and plate fixation of midshaft clavicle fractures between patients who achieved successful anatomical reduction and those who had a remaining fracture gap even after open reduction and plate fixation, and were thus treated with additional demineralized bone matrix (DBM). METHODS: This retrospective analysis was conducted on 56 consecutive patients who underwent open reduction and internal fixation using a locking compression plate for acute displaced midshaft clavicle fractures, and who underwent radiographic and clinical outcome evaluations at least 6 months postoperatively. The outcomes between those who achieved perfect anatomical reduction without remnant gap (n=32) and those who had a remaining fracture gap even after open reduction and plate fixation treated with additional DBM (n=24) were evaluated. RESULTS: There were no differences in the use of lag screws or wiring and operation time (all p>0.05) between those with and without remnant gap. No difference in the average radiological union time and clinical outcomes (satisfaction and Constant score) was observed between the two groups (all p>0.05). However, significantly faster union time was observed for AO type A fracture compared with other types (p=0.012), and traffic accident showed association with worse clinical outcomes compared with other causes of injury. CONCLUSIONS: Surgical outcome of midshaft clavicle fracture was more affected by initial fracture type and event, and re-reduction and re-fixation of the fracture to obtain a perfect anatomical reduction spending time appears to be unnecessary if rigid fixation is achieved.

Surgical Outcomes of Anterior Cervical Fusion Using Deminaralized Bone Matrix as Stand-Alone Graft Material: Single Arm, Pilot Study

OBJECTIVE: To investigate the safety and efficacy of demineralized bone matrix (DBM) as a bone graft substitute for anterior cervical discectomy and fusion (ACDF) surgery. METHODS: Twenty consecutive patients treated with ACDF using stand-alone polyestheretherketone (PEEK) cages (Zero-P) with DBM(CGDBM100) were prospectively evaluated with a minimum of 6 months of follow-up. Radiologic efficacy was evaluated with a 6-point scoring method for osseous fusion using plain radiograph and computed tomogrpahy scans. Clinical efficacy was evaluated using the visual analogue scale (VAS), Owestry disability index (ODI), and short-form health questionnaire-36. The safety of the bone graft substitute was assessed with vital sign monitoring and a survey measuring complications at each follow-up visit. RESULTS: There were significant improvements in VAS and ODI scores at a mean 6-month follow-up. Six months after surgery, solid fusion was achieved in all patients. Mean score on the 6-point scoring system was 5.1, and bony formation was found to score at least 4 points in all patients. There was no case with implant-related complications such as cage failure or migration, and no complications associated with the use of CGDBM100. CONCLUSION: ACDF using CGDBM100 demonstrated good clinical and radiologic outcomes. The fusion rate was comparable with the published results of traditional ACDF. Therefore, the results of this study suggest that the use of a PEEK cage packed with DBM for ACDF is a safe and effective alternative to the gold standard of autologous iliac bone graft.

Bone Union Rate Following Instrumented Posterolateral Lumbar Fusion: Comparison between Demineralized Bone Matrix versus Hydroxyapatite

STUDY DESIGN: Retrospective study. PURPOSE: To compare the union rate of posterolateral lumbar fusion (PLF) using demineralized bone matrix (DBM) versus hydroxyapatite (HA) as bone graft extender. OVERVIEW OF LITERATURE: To our knowledge, there has been no clinical trial to compare the outcomes of DBM versus HA as a graft material for PLF. METHODS: We analyzed prospectively collected data from consecutive 79 patients who underwent instrumented PLF. Patients who received DBM were assigned to group B (n=38), and patients who received HA were assigned into group C (n=41). The primary study outcome was fusion rate assessed with radiographs. The secondary outcomes included pain intensity using a visual analogue scale, functional outcome using Oswestry disability index score, laboratory tests of inflammatory profiles and infection rate. RESULTS: One year postoperatively, bone fusion was achieved in 73% in group B and 58% in group C without significant difference between the groups (p=0.15). There were no differences between the groups with respect to secondary outcomes. CONCLUSIONS: DBM would provide noninferior outcomes compared to the HA as a fusion material for PLF, and could be a notable alternative.

Rehabilitation effect of BMSCs that was transfected with hBMP-2 through adenovirus combination with DBM on rabbit osteonecrosis in femoral head / 天津医药

Objective To evaluate the effect of human bone morphogenetic protein 2 (hBMP-2)/Bone Mesenchymal Stem Cells (BMSCs)/demineralized bone matrix(DBM) on repairing rabbits’femoral head after necrosis and to explore the new treatments for femoral head necrosis. Methods Femoral head necrosis models was established by clinical core decom?pression combined with liquid nitrogen frozen. Then, animals were randomly devided into 4 groups (n=12 per group):Group A were not implanted anything as control group, Group B were implanted with DBM. Group C were implanted with hBMP-2/DBM. Group D were implanted with hBMP-2/BMSCs/DBM. Four rabbits from each group were sacrificed at 4,8 and 12 weeks after surgery to evaluate the the repairing effect of Osteonecrosis of the femoral head (ONFH) through X-ray examina?tion, observation of the specimen and HE staining. Results X-ray revealed defect of femoral head in Group A without clear bone formation. There is a little fibrous hyperplasia and no obvious osteogenic response. By contrast, the femoral head defect areas became fuzzy in group B, group C and group D with new bone trabeculars. And the regenerate phenomenons of group D were significantly better than that of group B and group C of the same time point. As to the Lane-Sandhu X Ray scores, it is lower in group A than that in group B;It is lower in group C than that in group D(P<0.05). There is no statistical difference between Group B and Group C. General observation of the specimen revealed that the femoral head of group A collapsed with drilling holes. The femoral heads of group B and group C showed no collapse but the drilling holes existed. Femoral head in group D was not collapsed and the drilling holes disappeared. HE staining showed that bone trabeculars became ne?crotic and fragmented in Group A with a lot of air trapped cells. There were newborn immature bone trabeculars and osteo? blasts in group B and group C. Group D were of large number of bone cells, fat cells, and newborn mature bone trabeculars. The ratio of empty lacuna is higher in Group A than that in Group B;it is higher in Group C than that in Group D(P<0.05). Conclusion hBMP-2/BMSCs/DBM can induce BMSCs differentiation into osteoblasts after being implanted. It has good re?pairing effect on ONFH with good application prospect.

A Prospective Randomized Clinical Trial Comparing Bone Union Rate Following Anterior Cervical Discectomy and Fusion Using a Polyetheretherketone Cage: Hydroxyapatite/B-Tricalcium Phosphate Mixture versus Hydroxyapatite/Demineralized Bone Matrix Mixture

STUDY DESIGN: Prospective randomized noninferiority trial. PURPOSE: To evaluate whether the union rate of anterior cervical discectomy and fusion (ACDF) using a polyetheretherketone (PEEK) cage filled with a mixture of hydroxyapatite (HA) and demineralized bone matrix (DBM) is inferior to that of a mixture of beta-tricalcium phosphate (beta-TCP) and HA. OVERVIEW OF LITERATURE: There have been no clinical trials investigating the outcomes of a mixture of HA and DBM in a PEEK cage in ACDF. METHODS: Eighty-five eligible patients were randomly assigned to group B (n=43), in which a PEEK cage with a mixture of HA and DBM was used, or group C (n=42), in which a PEEK cage with a mixture of HA and beta-TCP was used. The primary study endpoint was the fusion rate, which was assessed with dynamic radiographs and computed tomography (CT) scans. Secondary endpoints included pain intensity using a visual analogue scale, functional outcome using a neck disability index score, laboratory tests of inflammatory profiles, and the infection rate. RESULTS: Seventy-seven patients (38 in group B and 39 in group C) were included in the final analysis. One year postoperatively, bone fusion was achieved in 87% of group B patients and 87% of group C patients on dynamic radiographs, and 87% of group B patients and 72% of group C patients on CT scans (p=1.00 and 0.16, respectively). There were also no between-groups differences with respect to the secondary endpoints. CONCLUSIONS: A HA/DBM mixture inside a PEEK cage can provide noninferior outcomes compared to a HA/TCP mixture in ACDF.

Effectiveness of Posterolateral Lumbar Fusion Varies with the Physical Properties of Demineralized Bone Matrix Strip

STUDY DESIGN: A randomized, controlled animal study. PURPOSE: To investigate the effectiveness of fusion and new bone formation induced by demineralized bone matrix (DBM) strips with jelly strengths. OVERVIEW OF LITERATURE: The form of the DBM can make a difference to the outcome. The effect of different jelly strengths on the ability of DBM to form new bone is not known. METHODS: Forty-eight rabbits were randomized into a control group and two experimental groups. In the control group (group 1), 1.4 g of autologous iliac crest bone was placed bilaterally. In the experimental groups, a high jelly strength DBM-hyaluronic acid (HA)-gelatin strip (group 2) and a low jelly strength DBM-HA-gelatin strip (group 3) were used. The fusion was assessed with manual manipulation and radiographs. The volume of the fusion mass was determined from computed tomographic images. RESULTS: The fusion rates as determined by manual palpation were 37.5%, 93.8% and 50.0% in group 1, group 2, and group 3, respectively (p<0.05). By radiography, the fusion rate of High jelly strength DBM strip was statistically significantly greater than that of the other alternatives (p<0.05). The mean bone volume of the fusion mass as determined by computed tomography was 2,142.2+/-318.5 mm3, 3,132.9+/-632.1 mm3, and 2,741.5+/-380.4 mm3 in group 1, group 2, and group 3, respectively (p<0.05). CONCLUSIONS: These results indicate that differences in the structural and mechanical properties of gelatin that are associated with jelly strength influenced cellular responses such as cell viability and bony tissue ingrowth, facilitating greater bone fusion around high jelly strength implants.

Localized ridge defect augmentation using human pericardium membrane and demineralized bone matrix.

Background: Patient wanted to restore her lost teeth with implants in the lower left first molar and second premolar region. Cone beam computerized tomography (CBCT) revealed inadequate bone width and height around future implant sites. The extraction socket of second premolar area revealed inadequate socket healing with sparse bone fill after 4 months of extraction. Aim: To evaluate the clinical feasibility of using a collagen physical resorbable barrier made of human pericardium (HP) to augment localized alveolar ridge defects for the subsequent placement of dental implants. Materials and Methods: Ridge augmentation was done in the compromised area using Puros® demineralized bone matrix (DBM) Putty with chips and an HP allograft membrane. Horizontal (width) and vertical hard tissue measurements with CBCT were recorded on the day of ridge augmentation surgery, 4 month and 7 months follow‑up. Intra oral periapical taken 1 year after implant installation showed minimal crestal bone loss. Results: Bone volume achieved through guided bone regeneration was a gain of 4.8 mm horizontally (width) and 6.8 mm vertically in the deficient ridge within a period of 7 months following the procedure. Conclusion and Clinical Implications: The results suggested that HP Allograft membrane may be a suitable component for augmentation of localized alveolar ridge defects in conjunction with DBM with bone chips.

The Effect of Poloxamer 407-Based Hydrogel on the Osteoinductivity of Demineralized Bone Matrix

BACKGROUND: Demineralized bone matrix (DBM) is used for bone healing due to its osteoinductivity, but it requires a carrier for clinical application. Here, we report the effects on the osteoinductivity of DBM by use of a poloxamer 407-based hydrogel as the carrier, compared to sterile water. METHODS: DBM-W and DBM-H represent 27 wt% of DBM with sterile water and DBM with a poloxamer 407-based hydrogel, respectively. Both of the compositions were applied to human mesenchymal stem cell (MSC) cultures, and monitored for alkaline phosphatase (ALP) staining and ALP activity. Six 10-week-old athymic nude rats were used for abdominal muscle grafting with either DBM-W or DBM-H, and were tested by plane radiography, microfocus X-ray computed tomography (CT), and decalcified histology to evaluate ectopic bone formation. RESULTS: The DBM-W group showed stronger ALP staining at 7, 14, and 21 days of treatment, and significantly higher ALP activity at 7 and 14 days of treatment, compared to the DBM-H group. Plane radiography could not confirm the radio-opaque lesions in the rat ectopic bone formulation model. However, ectopic bone formation was observed in both groups by micro-CT. Compared to the DBM-H group, the DBM-W group showed higher bone volume, percent bone volume and trabecular number, and the difference in percent bone volume was statistically significant. Decalcified histology found bony tissue with lamellation in both groups. CONCLUSIONS: Our results suggest that poloxamer 407-based hydrogel has efficacy as a DBM carrier since it shows ectopic bone formation, but its effects on the quality and quantity of osteoblastic differentiation in rat abdominal ectopic bone and MSC are considered negative.

Demineralized Bone Matrix, as a Graft Enhancer of Auto-Local Bone in Posterior Lumbar Interbody Fusion

STUDY DESIGN: A case controlled study with prospective data collection. PURPOSE: To evaluate the early influence and the final consequence of demineralized bone matrix (DBM) on auto-local bone as a graft enhancer in posterior lumbar interbody fusion (PLIF). OVERVIEW OF LITERATURE: DBM is known as an osteoinductive material; however, it has not been clearly recognized to enhance auto-local bone with a small amount. METHODS: Patients who had a PLIF were allocated into two groups. Group I (70 cases) used auto-local bone chips and group II (44 cases) used DBM as an additive to auto-local bone, 1 mL per a segment. Group selection was alternated. Early assessment was performed by computed tomography at 6 months and final assessment was done by simple radiography after 24 months at least. The degree of bone formation was assessed by 4 grade scale. RESULTS: The subjects of both groups were homogenous and had similar Oswestry Disability Index at final assessment. The ratio of auto-local bone chips and DBM was 6:1. The degree of bone formation at 6 months after surgery was superior in group II. However, there was no significant difference between the two groups at the final assessment. CONCLUSIONS: DBM was not recognized to enhance auto-local bone with small amount.

Stabilizing effects of a particulate demineralized bone matrix in the L4 interbody space with and without PEEK Cage: a literature review and preliminary results of a cadaveric biomechanical study / Estabilización de los efectos de una matriz osea desmineralizada Particulada en el espacio intersomático a nivel L4 con o sin cajetín PEEK: revisión de la literatura y resultados preliminares de un estudio biomecánico cadavérico

We reviewed the biological elements supporting the usefulness of a specifically designed particulate form of demineralized bone matrix (DBM) in spinal fusion, and report some limitations of its use described in the medical literature and in the interbody space using a cadaveric biomechanical model. A literature review and description of the techniques used to augment spinal fusion are presented, including a more thorough review of recent findings of cadaveric biomechanical flexibility studies using DBM alone at different percentage fills of the existing disc space and DBM with a polyetheretherketone (PEEK) interbody cage. The need for DBM was established by reviewing limitations of autografts and allografts in spinal fusion. Demineralized bone matrix used alone did not increase stability post discectomy at L4-L5, but was demonstrated to exhibit satisfactory stability when used with a PEEK interbody cage. There may be a future role for DBM that hardens and fills disc space more rigidly, overcoming this limitation to its use.

Examinamos los elementos biológicos que respaldan la utilidad de una forma particulada específicamente diseñada de matriz ósea desmineralizada (MOD) con fusión espinal. Asimismo reportamos algunas limitaciones de su uso en el espacio intersomático descritas en la literatura médica, mediante un modelo biomecánico cadavérico. Se presenta una revisión de la literatura, acompañada de una descripción de las técnicas utilizadas para aumentar la fusión espinal, incluyendo una revisión más exhaustiva de los hallazgos recientes de los estudios de flexibilidad biomecánico cadavérica, utilizando sólo MOD en diferentes rellenos de porcentajes del espacio discal existente, y MOD con cajetines intervertebrales de polieteretercetona (PEEK). La necesidad de MOD se estableció examinando las limitaciones de los autoinjertos y los aloinjertos en la fusión espinal. El uso de la matriz ósea desmineralizada sola, no aumentaba la estabilidad post-disectómica a nivel L4-L5, pero se demostró que presentaba una estabilidad satisfactoria cuando se utilizaba con un cajetín intervertebral PEEK. Puede haber un papel futuro para un MOD que se endurezca y rellene el espacio del disco más rígidamente, venciendo así esta limitación a su uso.

Diagnostic Usefulness of White Blood Cell and Absolute Neutrophil Count for Postoperative Infection after Anterior Cervical Discectomy and Fusion Using Allograft and Demineralized Bone Matrix

STUDY DESIGN: Prospective study. PURPOSE: We investigated normative temporal levels of white blood cell (WBC) and absolute neutrophil count (ANC) in uncomplicated anterior cervical discectomy and fusion (ACDF) using allograft and demineralized bone matrix (DBM). OVERVIEW OF LITERATURE: No study has investigated the diagnostic usefulness of WBC and ANC for postoperative infection following ACDF using allograft and DBM. METHODS: Blood samples of 85 patients, who underwent one or two-level ACDF, were obtained and evaluated before surgery and on the first, third, fifth, seventh, fourteenth, thirtieth, and ninetieth postoperative days. No infection was found in all patients for at least one year follow-up period. RESULTS: Mean WBC and ANC values increased significantly and reached peak levels on the first postoperative day. The peaked levels rapidly decreased but still remained elevated above the preoperative levels on the third postoperative day. The levels returned close to the preoperative levels on the fifth postoperative day. The mean WBC and ANC values did not get out of their normal reference ranges throughout the follow-up periods. One-level and two-level ACDF exhibited a similar course of postoperative changes in WBC and ANC values and no significant difference in mean levels of WBC and ANC throughout the follow-up periods. CONCLUSIONS: Uncomplicated ACDF using allograft and DBM showed normal values of WBC and ANC during the early postoperative period. Therefore, significant abnormal values of WBC and ANC at an early postoperative period suggest the possibility of the development of acute postoperative infection after ACDF using allograft and DBM.

Evaluation of bone healing in canine tibial defects filled with cortical autograft, commercial-DBM, calf fetal DBM, omentum and omentum-calf fetal DBM

The present study was conducted to compare the effects of xenogenic bovine fetal demineralized bone matrix (DBM), commercial DBM, omentum, omentum-calf fetal DBM, cortical autograft and xenogenic cartilage powder on the healing of tibial defects in a dog model to determine the best material for bone healing. Seven male adult mongrel dogs, weighing 26.2 +/- 2.5 kg, were used in this study. Seven holes with a diameter of 4-mm were created and then filled with several biomaterials. Radiographs were taken postoperatively on day 1 and weeks 2, 4, 6, 8. The operated tibias were removed on the 56th postoperative day and histopathologically evaluated. On postoperative days 14, 42 and 56, the lesions of the control group were significantly inferior to those in the other group (p < 0.05). On the 28th postoperative day, the autograft group was significantly superior to the control and omentum groups (p < 0.05). Moreover, calf fetal DBM was significantly superior to the control group. There was no significant difference between the histopathological sections of all groups. Overall, the omentum and omentum-DBM groups were superior to the control group, but inferior to the autograft, commercial-DBM, calf fetal DBM and calf fetal cartilage groups.

Guided bone regeneration using demineralized allogenic bone matrix with calcium sulfate: case series

PURPOSE: The purpose of this case series was to evaluate the effect of guided bone regeneration using demineralized allogenic bone matrix with calcium sulfate. MATERIALS AND METHODS: Guided bone regeneration using Demineralized Allogenic Bone Matrix with Calcium Sulfate (AlloMatrix(TM), Wright. USA) was performed at the time of implant placement from February 2010 to April 2010. At the time of the second surgery, clinical evaluation of bone healing and histologic evaluation were performed. The study included 10 patients, and 23 implants were placed. The extent of bony defects around implants was determined by measuring the horizontal and vertical bone defects using a periodontal probe from the mesial, distal, buccal, and lingual sides and calculating the mean and standard deviation of these measurements. Wedge-shaped tissue samples were obtained from 3 patients and histologic examination was performed. RESULTS: In clinical evaluation, it was observed that horizontal bone defects were completely healed with new bones, and in the vertical bone defect area, 15.1% of the original defect area remained. In 3 patients, histological tests were performed, and 16.7-41.7% new bone formation was confirmed. Bone graft materials slowly underwent resorption over time. CONCLUSION: AlloMatrix(TM) is an allograft material that can be readily manipulated. It does not require the use of barrier membranes, and good bone regeneration can be achieved with time.

Early Result of Demineralized Bone Matrix (DBM, Genesis(R)) in Bone Defect after Operative Treatment of Benign Bone Tumor / 대한골관절종양학회지

PURPOSE: This study was performed to evaluate the efficiency of demineralized bone matrix (DBM, Genesis(R)) used for bone defect after operative traetment of benign bone tumors by clinical and radiological methods. MATERIALS AND METHODS: DBM was used to treat bone defect after operative treatment of benign tumor from February 2012 to May 2013. Total 25 benign bone tumor cases (15 males, and 10 females) with mean age of 30.3 were studied. The diagnoses were solitary bone cyst in 9 cases, non ossifying fibroma in 5, fibrous dysplasia in 5, aneurysmal bone cyst in 3 and enchondroma in 3. In categorization by location of tumor, there were 5 cases of distal femur, 4 of proximal tibia, 3 of proximal femur, 3 of proximal humerus, 3 of phalanx, 2 of distal radius, 2 of hip bone, 2 of calcaneus, and 1 of scapula. Autogenous bone was used with DBM in 6 cases, and only DBM used in 19 cases. Mean periods of follow up were 8.7 months (range: 6 to 14 months). Amount of graft resorption and bone formation was observed with compare of post operation radiograph and the difference was shown by percentage. Resorption level was measured by DBM level which could be observed from simple x-ray, and bone formation level by bone trabecular formation level at impaired site. RESULTS: Twenty three cases of total 25 cases showed bone union. In the 23 cases, more than 98% DBM resorption was observed after mean 4.3 months, and more than 98% bone formation was observed after mean 6.9 months. Lesser bone defect sizes showed faster bone formation and it was statistically significant (p=0.036). But other comparative studies on other factors such as, sex, age of patients and combination of autogenous bone were no statistically significant differences in graft resorption and bone formation. And there was no significant complication in periods of follow-up. CONCLUSION: Demineralized Bone Matrix (Genesis(R)) is thought to be useful treatment for bone defect after operative treatment of benign bone tumor, however longer follow-up periods appears to be needed.