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Bone Injury, Healing and Grafting
Published in Manoj Ramachandran, Tom Nunn, Basic Orthopaedic Sciences, 2018
Peter Bates, Andrea Yeo, Manoj Ramachandran
Tissue is harvested from one individual and implanted into another individual of the same species. The host is likely to mount an immune response to the cells of a fresh allograft and, therefore, the graft is processed in order to remove immunogenic cells, decreasing the risk of both immune response and transmission of infection. Allografts can be classified according to following: Anatomy: cortical, cancellous, corticocancellous.Processing: fresh, frozen, freeze-dried, demineralized bone matrix.Sterilization method: sterile processing, irradiated, ethylene oxide.Handling properties: powder, gel, paste/putty, chips, strips/blocks, massive.
Orthopaedic operations
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Michael Whitehouse, David Warwick, Ashley Blom
Fresh allografts, though dead, are not immunologically acceptable. They induce an inflammatory response in the host and this may lead to rejection. However, antigenicity can be reduced by freezing (at –70 °C), freeze-drying or by ionizing radiation. Demineralization is another way of reducing antigenicity and it may also enhance the osteoinductive properties of the graft. Acid extraction of allograft bone yields demineralized bone matrix, which contains collagen and growth factors. It is available in a variety of forms (putty, powder, granules) and is sometimes combined with other types of bone substitutes. The osteoinductive capability of demineralized bone matrix is variable; most human studies have not shown the impressive osteoinductive capacity found in animal experiments. One way to supplement the properties of demineralized bone matrix is to use it as an autologous bone graft expander.
Reduction and Fixation of Sacroiliac joint Dislocation by the Combined Use of S1 Pedicle Screws and an Iliac Rod
Published in Kai-Uwe Lewandrowski, Donald L. Wise, Debra J. Trantolo, Michael J. Yaszemski, Augustus A. White, Advances in Spinal Fusion, 2003
Kai-Uwe Lewandrowski, Donald L. Wise, Debra J. Trantolo, Michael J. Yaszemski, Augustus A. White
can achieve a higher fusion rate than autograft alone [9-11]. Additional research has focused on using hydroxyapatite or tricalcium phosphate as potential carriers. Both are minerals found in normal bone matrix. Hydroxyapatite has been found to provide adequate structural support but is not readily reabsorbed during the healing of the spinal fusion. Conversely, tricalcium phosphate, while not having the structural stability of hydroxyapatite, is more easily resorbed during the healing phase [12]. Both of these materials have been shown to withstand the compression forces of the paraspinal muscles in the intertransverse process location. This has not been the case with collagen sponges. The collagen sponge has proved to be the carrier of choice with protective cages or interbody devices for anterior or lateral interbody fusion. The potential for exogenous bone formation following application for BMP to collagen sponges has precluded the use of this preparation via posterior or transforamenal interbody approaches. Demineralized Bone Matrix
Platelet Rich Plasma in Orthopedic Surgical Medicine.
Published in Platelets, 2021
Peter A. Everts, Albert van Erp, Alfred DeSimone, Dan S. Cohen, Ronald D. Gardner
Improvements in life expectancy over the past century and innovations in spinal instrumentation have contributed to an increase in the number of neuro-orthopedic spinal fusion surgeries to treat spinal instability and deformities resulting from various spinal pathologies [78,79]. Spinal fusion is now a common procedure, and the results have improved because of advances in surgical technique and spinal implants [80], albeit that despite these advanced techniques, pseudarthrosis with failure of bony implant-fusion remains as a serious complication. Therefore, while autografting remains the gold standard in spinal fusion, additional materials and biologics, including PRP, are employed to enhance the fusion rate [81,82]. Ceramics, demineralized bone matrix, and bone morphogenetic proteins (BMPs) have also been used in lumbar fusion surgeries to avoid serious complications including infection, hematoma, fracture, and wound healing disturbances [83]. Notably, the US Food and Drug Administration does not recommend the use of BMP-2 and BMP-7 in cervical fusion surgery.
Budget impact analysis of demineralized bone matrix in combination with autograft in lumbar spinal fusion procedures for the treatment of lumbar degenerative disc disease in Spain
Published in Journal of Medical Economics, 2018
Kirk Geale, María Álvarez, Maria Polyzoi, Xavier Màlaga, Cristina Pineda, César Hernández
Due to the shortcomings associated with local and iliac crest autograft, innovative graft substitutes and extenders have been developed and adopted by practitioners. Ceramic-based grafts such as beta tri-calcium phosphate (beta-TCP) provide a synthetic osteoconductive alternative to bone graft. A second type of graft extender is demineralized bone matrix (DBM), a demineralized allograft which exposes concentrated organic bone morphogenetic proteins, resulting in a collagen bone matrix with osteoconductive and osteoinductive properties20. Due to the lack of osteogenic properties, DBM is typically used as a bone graft extender together with LA, instead of as a replacement. Studies have shown that this approach has similar arthrodesis rates compared to supplementation with ICBG21–23.
Escherichia coli BMP-2 showed comparable osteoinductivity with Chinese hamster ovary derived BMP-2 with demineralized bone matrix as carrier
Published in Growth Factors, 2019
Yuan-Zhe Jin, Guang-Bin Zheng, Jae Hyup Lee
Among the delivery systems (Vishal and Mukty 2017) demineralized bone matrix (DBM) was both osteoconductive and osteoinductive, and it has been used as a scaffold for bone regeneration (Schouten et al. 2005; Wildemann et al. 2007; Tilkeridis et al. 2014; Kim et al. 2015). Therefore, the bone regeneration effect might be improved by using DBM as a delivery system for ErhBMP-2, but the effect of ErhBMP-2 with DBM as a carrier was less investigated. Therefore, we compared the osteoinductivity of ErhBMP-2 and CrhBMP-2 while both were loaded with DBM.