Use of demineralized bone matrix in spinal fusion

Abstract

Spinal fusion remains the gold-standard treatment for several pathological spine conditions. Although, autologous Iliac Crest Bone Grafting is considered the gold-standard graft choice to promote spinal fusion; however, it is associated with significant donor site morbidity and a limited graft quantity. Therefore, several bone graft alternatives have been developed, to augment arthrodesis. The purpose of this review is to present the results of clinical studies concerning the use of demineralized bone matrix (DBM), alone or as a composite graft, in the spinal fusion. A critical review of the English-language literature was conducted on Pubmed, using key word “demineralized bone matrix”, “DBM”, “spinal fusion”, and “scoliosis”. Results had been restricted to clinical studies. The majority of clinical trials demonstrate satisfactory fusion rates when DBM is employed as a graft extender or a graft enhancer. Limited number of prospective randomized controlled trials (4 studies), have been performed comparing DBM to autologous iliac crest bone graft in spine fusion. The majority of the clinical trials demonstrate comparable efficacy of DBM when it used as a graft extender in combination with autograft, but there is no clinical evidence to support its use as a standalone graft material. Additionally, high level of evidence studies are required, in order to optimize and clarify the indications of its use and the appropriate patient population that will benefit from DBM in spine arthrodesis.

Keywords: Bone grafts; Demineralized bone matrix; Spinal fusion; Scoliosis

Core tip: It is widely accepted that autologous iliac crest bone graft (ICBG) is considered the gold-standard for spinal fusion surgery, although it is associated with a series of complications and a morbidity rate. Demineralized bone matrix (DBM) could be successfully used as a potential graft extender, enhancer or substitute. Spinal surgeons can take advance of DBMs osteoinductivity and osteoconductivity and achieve good results in spinal fusion, with a significantly lower complication rate and results similar to these of ICBG. The most significant drawbacks to DBM may be the difference between and within products so, it is important the surgeon to remain updated of the product properties to optimize the successful use of DBM, and the fact that it is not useful as a structural graft material because of its amorphous consistency, so it has to be used in combination with other type of grafts or scaffolds increasing the cost.