Bone grafts and bone morphogenetic proteins in spine fusion |
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Authors: | Munish C Gupta Sukanta Maitra |
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Institution: | (1) Department of Orthopaedics, Davis Medical Center, University of California, Suite 3800, 4860 Y Street, Sacramento, 95817, USA |
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Abstract: | Spinal fusions are being performed for various pathologies of the spine. Stabilizing vertebral segments by eliminating motion
across those segments becomes critical in dealing with pathologies of the spine that lead to instability. The use of autograft
has been the gold standard for spine fusion. However, due to complications such as donor site morbidity, increased operating
time, and limited supply, the use of allograft as a graft extender has become an acceptable practice especially in fusions
spanning multiple segments. The discovery and isolation of novel proteins (i.e., bone morphogenetic proteins, BMPs), which
initiate the molecular cascade of bone formation, have experimentally been shown in numerous animal studies to be as effective
as autografts. Although the use of BMPs has exciting applications in spine surgery, long-term clinical studies must be evaluated
for its efficacy in various applications in humans. The use of biomimetic materials such as hydroxyapatite (HA), or tricalcium
phosphate (TCP) has also been examined in several animal models as bone graft substitutes or carriers. Although these materials
have shown some promise in specific site applications, more work remains in elucidating an efficacious combination of these
materials and BMPs that can be as effective as autografts. This review will present the status of bone grafts, bone morphogenetic
proteins, gene therapy, and work that has been done to facilitate spinal fusion and simultaneously eliminate the need for
bone graft.
This revised version was published online in July 2006 with corrections to the Cover Date. |
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Keywords: | BMPs Bone grafts GDF-5 Hydroxyapatite Spine fusion Tricalcium phosphate |
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