Allograft Versus Demineralized Bone Matrix in Instrumented and Noninstrumented Lumbar Fusion: A Systematic Review

Zorica Buser; Darrel S. Brodke; Jim A. Youssef; Elke Rometsch; Jong Beom Park; S. Tim Yoon; Jeffrey C. Wang; Hans Joerg Meisel

doi:10.1177/2192568217735342

Allograft Versus Demineralized Bone Matrix in Instrumented and Noninstrumented Lumbar Fusion: A Systematic Review

Zorica Buser, Darrel S. Brodke, Jim A. Youssef, Elke Rometsch, Jong Beom Park, S. Tim Yoon, Jeffrey C. Wang, Hans Joerg Meisel

Research output: Contribution to journal › Review article › peer-review

28 Scopus citations

Abstract

Study Design: Systematic review. Objectives: The aim was to determine the fusion efficacy of allograft and demineralized bone matrix (DBM) in lumbar instrumented and noninstrumented fusion procedures for degenerative lumbar disorders. Methods: A literature search was conducted using the PubMed and Cochrane databases. To be considered, publications had to meet 4 criteria: patients were treated for a degenerative lumbar disorder, a minimum group size of 10 patients, use of allograft or DBM, and at least a 2-year follow-up. Data on the study population, follow-up time, surgery type, grafting material, fusion rates, and its definition were collected. Results: The search yielded 692 citations with 17 studies meeting the criteria including 4 retrospective and 13 prospective studies. Six studies used DBM and 11 employed allograft alone or in the combination with autograft. For the allograft, fusion rates ranged from 58% to 68% for noninstrumented and from 68% to 98% for instrumented procedures. For DBM, fusion rates were 83% for noninstrumented and between 60% and 100% for instrumented lumbar fusion procedures. Conclusions: Both allograft and DBM appeared to provide similar fusion rates in instrumented fusions. On the other hand, in noninstrumented procedures DBM was superior. However, a large variation in the type of surgery, outcomes collection, lack of control groups, and follow-up time prevented any significant conclusions. Thus, studies comparing the performance of allograft and DBM to adequate controls in large, well-defined patient populations and with a sufficient follow-up time are needed to establish the efficacy of these materials as adjuncts to fusion.

Original language	English
Pages (from-to)	396-412
Number of pages	17
Journal	Global Spine Journal
Volume	8
Issue number	4
DOIs	https://doi.org/10.1177/2192568217735342
State	Published - 1 Jun 2018

Bibliographical note

Funding Information:
The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Financial activities outside of submitted work: ZB-Xenco Medical (consultancy) and AO Spine (consultancy, past). JBP and ER—Nothing to disclose. HJM—Dr Meisel is a consultant (money paid to institution): Regenerate Life Sciences GmbH for Zyga, DiFu-sion (ongoing), Co.don (paid to Dr Meisel, past); royalties from Med-tronic, Fehling Aesculap (past); owns stocks (money paid to institution): Regenerate Life Sciences GmbH in DiFusion. STY—Dr Yoon owns stock in Phygen, Alphatec, Meditech; royalties: Meditech Advisors, Stryker Spine (paid directly to institution/employer), grant from AOSpine (paid directly to institution/employer), research support from Biomet (research support given to AREF), nonfinancial research support from Nuvasive and Medtronic. JAY—Royalties: NuVasive, Osprey Medical, Amedica, Integra; Stock ownership: Ben-venue Medical, Paradigm Spine, Promethean Surgical Devices, Spinal Ventures, VertiFlex, Spinicity, ISD, Providence Medical; Private investments: Amedica, VertiFlex, Benvenue, NuVasive; Consulting: Integra, NuVasive, Amedica, HealthTrust; Board of directors: Durango Orthopedic Associates (None); Research support (staff and/or materials): Globus Medical (paid directly to institution/employer), NuVasive (paid directly to institution/employer), VertiFlex (paid directly to institution/employer), Integra (paid directly to institution/ employer). DSB—Consultant: Vallum; Royalties: Amedica, DePuy Synthes, Medtronic; Fellowship support: AOSpine (paid directly to institution). JCW—Royalties: Aesculap, Biomet, Amedica, Seaspine, Synthes; Stock ownership: Fziomed; Private investments: Promethean Spine, Paradigm Spine, Benevenue, NexGen, Vertiflex, Electrocore,

Funding Information:
Surgitech, Expanding Orthopaedics, Osprey, Bone Biologics, Curative Biosciences, Pearldiver; Board of directors: North American Spine Society (Second Vice President), North American Spine Foundation (nonfinancial), Cervical Spine Research Society (travel expenses), AO Spine/AO Foundation (honorariums for board position); Fellowship support: AO Foundation (spine fellowship funding paid to institution).

Publisher Copyright:
© 2017, The Author(s) 2017.

Keywords

allograft
autograft
demineralized bone matrix
lumbar spine
spinal fusion
systematic review

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10.1177/2192568217735342

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@article{603ccdc3fe30412597e33b4ffd7284eb,

title = "Allograft Versus Demineralized Bone Matrix in Instrumented and Noninstrumented Lumbar Fusion: A Systematic Review",

abstract = "Study Design: Systematic review. Objectives: The aim was to determine the fusion efficacy of allograft and demineralized bone matrix (DBM) in lumbar instrumented and noninstrumented fusion procedures for degenerative lumbar disorders. Methods: A literature search was conducted using the PubMed and Cochrane databases. To be considered, publications had to meet 4 criteria: patients were treated for a degenerative lumbar disorder, a minimum group size of 10 patients, use of allograft or DBM, and at least a 2-year follow-up. Data on the study population, follow-up time, surgery type, grafting material, fusion rates, and its definition were collected. Results: The search yielded 692 citations with 17 studies meeting the criteria including 4 retrospective and 13 prospective studies. Six studies used DBM and 11 employed allograft alone or in the combination with autograft. For the allograft, fusion rates ranged from 58% to 68% for noninstrumented and from 68% to 98% for instrumented procedures. For DBM, fusion rates were 83% for noninstrumented and between 60% and 100% for instrumented lumbar fusion procedures. Conclusions: Both allograft and DBM appeared to provide similar fusion rates in instrumented fusions. On the other hand, in noninstrumented procedures DBM was superior. However, a large variation in the type of surgery, outcomes collection, lack of control groups, and follow-up time prevented any significant conclusions. Thus, studies comparing the performance of allograft and DBM to adequate controls in large, well-defined patient populations and with a sufficient follow-up time are needed to establish the efficacy of these materials as adjuncts to fusion.",

keywords = "allograft, autograft, demineralized bone matrix, lumbar spine, spinal fusion, systematic review",

author = "Zorica Buser and Brodke, {Darrel S.} and Youssef, {Jim A.} and Elke Rometsch and Park, {Jong Beom} and Yoon, {S. Tim} and Wang, {Jeffrey C.} and Meisel, {Hans Joerg}",

note = "Funding Information: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Financial activities outside of submitted work: ZB-Xenco Medical (consultancy) and AO Spine (consultancy, past). JBP and ER—Nothing to disclose. HJM—Dr Meisel is a consultant (money paid to institution): Regenerate Life Sciences GmbH for Zyga, DiFu-sion (ongoing), Co.don (paid to Dr Meisel, past); royalties from Med-tronic, Fehling Aesculap (past); owns stocks (money paid to institution): Regenerate Life Sciences GmbH in DiFusion. STY—Dr Yoon owns stock in Phygen, Alphatec, Meditech; royalties: Meditech Advisors, Stryker Spine (paid directly to institution/employer), grant from AOSpine (paid directly to institution/employer), research support from Biomet (research support given to AREF), nonfinancial research support from Nuvasive and Medtronic. JAY—Royalties: NuVasive, Osprey Medical, Amedica, Integra; Stock ownership: Ben-venue Medical, Paradigm Spine, Promethean Surgical Devices, Spinal Ventures, VertiFlex, Spinicity, ISD, Providence Medical; Private investments: Amedica, VertiFlex, Benvenue, NuVasive; Consulting: Integra, NuVasive, Amedica, HealthTrust; Board of directors: Durango Orthopedic Associates (None); Research support (staff and/or materials): Globus Medical (paid directly to institution/employer), NuVasive (paid directly to institution/employer), VertiFlex (paid directly to institution/employer), Integra (paid directly to institution/ employer). DSB—Consultant: Vallum; Royalties: Amedica, DePuy Synthes, Medtronic; Fellowship support: AOSpine (paid directly to institution). JCW—Royalties: Aesculap, Biomet, Amedica, Seaspine, Synthes; Stock ownership: Fziomed; Private investments: Promethean Spine, Paradigm Spine, Benevenue, NexGen, Vertiflex, Electrocore, Funding Information: Surgitech, Expanding Orthopaedics, Osprey, Bone Biologics, Curative Biosciences, Pearldiver; Board of directors: North American Spine Society (Second Vice President), North American Spine Foundation (nonfinancial), Cervical Spine Research Society (travel expenses), AO Spine/AO Foundation (honorariums for board position); Fellowship support: AO Foundation (spine fellowship funding paid to institution). Publisher Copyright: {\textcopyright} 2017, The Author(s) 2017.",

year = "2018",

month = jun,

day = "1",

doi = "10.1177/2192568217735342",

language = "English",

volume = "8",

pages = "396--412",

journal = "Global Spine Journal",

issn = "2192-5682",

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TY - JOUR

T1 - Allograft Versus Demineralized Bone Matrix in Instrumented and Noninstrumented Lumbar Fusion

T2 - A Systematic Review

AU - Buser, Zorica

AU - Brodke, Darrel S.

AU - Youssef, Jim A.

AU - Rometsch, Elke

AU - Park, Jong Beom

AU - Yoon, S. Tim

AU - Wang, Jeffrey C.

AU - Meisel, Hans Joerg

N1 - Funding Information: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Financial activities outside of submitted work: ZB-Xenco Medical (consultancy) and AO Spine (consultancy, past). JBP and ER—Nothing to disclose. HJM—Dr Meisel is a consultant (money paid to institution): Regenerate Life Sciences GmbH for Zyga, DiFu-sion (ongoing), Co.don (paid to Dr Meisel, past); royalties from Med-tronic, Fehling Aesculap (past); owns stocks (money paid to institution): Regenerate Life Sciences GmbH in DiFusion. STY—Dr Yoon owns stock in Phygen, Alphatec, Meditech; royalties: Meditech Advisors, Stryker Spine (paid directly to institution/employer), grant from AOSpine (paid directly to institution/employer), research support from Biomet (research support given to AREF), nonfinancial research support from Nuvasive and Medtronic. JAY—Royalties: NuVasive, Osprey Medical, Amedica, Integra; Stock ownership: Ben-venue Medical, Paradigm Spine, Promethean Surgical Devices, Spinal Ventures, VertiFlex, Spinicity, ISD, Providence Medical; Private investments: Amedica, VertiFlex, Benvenue, NuVasive; Consulting: Integra, NuVasive, Amedica, HealthTrust; Board of directors: Durango Orthopedic Associates (None); Research support (staff and/or materials): Globus Medical (paid directly to institution/employer), NuVasive (paid directly to institution/employer), VertiFlex (paid directly to institution/employer), Integra (paid directly to institution/ employer). DSB—Consultant: Vallum; Royalties: Amedica, DePuy Synthes, Medtronic; Fellowship support: AOSpine (paid directly to institution). JCW—Royalties: Aesculap, Biomet, Amedica, Seaspine, Synthes; Stock ownership: Fziomed; Private investments: Promethean Spine, Paradigm Spine, Benevenue, NexGen, Vertiflex, Electrocore, Funding Information: Surgitech, Expanding Orthopaedics, Osprey, Bone Biologics, Curative Biosciences, Pearldiver; Board of directors: North American Spine Society (Second Vice President), North American Spine Foundation (nonfinancial), Cervical Spine Research Society (travel expenses), AO Spine/AO Foundation (honorariums for board position); Fellowship support: AO Foundation (spine fellowship funding paid to institution). Publisher Copyright: © 2017, The Author(s) 2017.

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Study Design: Systematic review. Objectives: The aim was to determine the fusion efficacy of allograft and demineralized bone matrix (DBM) in lumbar instrumented and noninstrumented fusion procedures for degenerative lumbar disorders. Methods: A literature search was conducted using the PubMed and Cochrane databases. To be considered, publications had to meet 4 criteria: patients were treated for a degenerative lumbar disorder, a minimum group size of 10 patients, use of allograft or DBM, and at least a 2-year follow-up. Data on the study population, follow-up time, surgery type, grafting material, fusion rates, and its definition were collected. Results: The search yielded 692 citations with 17 studies meeting the criteria including 4 retrospective and 13 prospective studies. Six studies used DBM and 11 employed allograft alone or in the combination with autograft. For the allograft, fusion rates ranged from 58% to 68% for noninstrumented and from 68% to 98% for instrumented procedures. For DBM, fusion rates were 83% for noninstrumented and between 60% and 100% for instrumented lumbar fusion procedures. Conclusions: Both allograft and DBM appeared to provide similar fusion rates in instrumented fusions. On the other hand, in noninstrumented procedures DBM was superior. However, a large variation in the type of surgery, outcomes collection, lack of control groups, and follow-up time prevented any significant conclusions. Thus, studies comparing the performance of allograft and DBM to adequate controls in large, well-defined patient populations and with a sufficient follow-up time are needed to establish the efficacy of these materials as adjuncts to fusion.

AB - Study Design: Systematic review. Objectives: The aim was to determine the fusion efficacy of allograft and demineralized bone matrix (DBM) in lumbar instrumented and noninstrumented fusion procedures for degenerative lumbar disorders. Methods: A literature search was conducted using the PubMed and Cochrane databases. To be considered, publications had to meet 4 criteria: patients were treated for a degenerative lumbar disorder, a minimum group size of 10 patients, use of allograft or DBM, and at least a 2-year follow-up. Data on the study population, follow-up time, surgery type, grafting material, fusion rates, and its definition were collected. Results: The search yielded 692 citations with 17 studies meeting the criteria including 4 retrospective and 13 prospective studies. Six studies used DBM and 11 employed allograft alone or in the combination with autograft. For the allograft, fusion rates ranged from 58% to 68% for noninstrumented and from 68% to 98% for instrumented procedures. For DBM, fusion rates were 83% for noninstrumented and between 60% and 100% for instrumented lumbar fusion procedures. Conclusions: Both allograft and DBM appeared to provide similar fusion rates in instrumented fusions. On the other hand, in noninstrumented procedures DBM was superior. However, a large variation in the type of surgery, outcomes collection, lack of control groups, and follow-up time prevented any significant conclusions. Thus, studies comparing the performance of allograft and DBM to adequate controls in large, well-defined patient populations and with a sufficient follow-up time are needed to establish the efficacy of these materials as adjuncts to fusion.

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KW - autograft

KW - demineralized bone matrix

KW - lumbar spine

KW - spinal fusion

KW - systematic review

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U2 - 10.1177/2192568217735342

DO - 10.1177/2192568217735342

M3 - Review article

AN - SCOPUS:85048985119

SN - 2192-5682

VL - 8

SP - 396

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JO - Global Spine Journal

JF - Global Spine Journal

IS - 4

ER -

Allograft Versus Demineralized Bone Matrix in Instrumented and Noninstrumented Lumbar Fusion: A Systematic Review

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Keywords

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