DBM sponges led to 94% fusion rate in posterolateral lumbar spine surgery

Fusion rates with the sponges were comparable to rates with autograft bone.

Compared to autograft bone, which is considered the gold standard graft material for spine fusion, demineralized bone matrix in the form of a sponge was associated with comparable fusion rates and less pain when used for posterolateral lumbar fusion, according to a presenter.

B. Victor Yoon, MS, of Hospital for Special Surgery, in New York City, said demineralized bone matrix (DBM) is readily available, is safe and avoids any second site morbidity with posterolateral lumbar fusion in a presentation based on cases of Andrew A. Sama, MD, of Hospital for Special Surgery.

“Demineralized bone sponge achieves satisfactory fusion without the morbidity related to autograft from iliac crest bone graft harvesting,” Yoon said at the Philadelphia Spine Research Symposium.

The gold standard

Autograft is the gold standard in these cases because there is no risk of disease transmission, it is histocompatible and its properties are ideal for successful healing, Yoon said.

“There are lots of advantages to using your own bone cells and bone graft [because] it is usually coming from your healthy cells, it contains all three of the properties that you need for the graft to be effective. It is osteoconductive, osteoinductive and osteogenic, all at the same time,” he said.

However, there is a limited supply of a patient’s iliac crest autograft bone and the harvest process may be associated with increased pain, morbidity and infection. Surgeons are basically harvesting the material from a patient’s healthy pelvic bone, which leads to damage and a second site of surgery, according to Yoon.

In worst case scenarios, harvesting the iliac crest autograft can actually increase the chances for bone fracture, he said.

DBM sponge found effective

On the other hand, DBM in a sponge form is easy to use and readily available, Yoon said. It is porous, compressible and can effectively absorb fluid like blood or bone marrow. It is effective for use in posterolateral lumbar fusion, interbody fusion procedures, cervical fusion procedures, deformity procedures and other spinal surgical fusion procedures, Yoon said.

Yoon and colleagues studied fusion rates using OsteoSponge (Bacterin) DBM sponge in 122 patients who underwent posterolateral lumbar fusion and they used 2.73 sponges, on average, per patient and available, morcelized local bone from the surgical preparation.The patients’ mean BMI was 30.17.

At final follow-up, four patients experienced nonunion, three patients had a questionable fusion mass and no patients underwent revision surgery.

In all, 115 patients of the 122 patients achieved solid fusion for a 94.26% fusion rate as evaluated by standard radiographic films, which Yoon said is comparable to published fusion rates with autograft.

The patients’ VAS back pain scores decreased from 6.76 preoperatively to 2.85 postoperatively and their VAS leg pain scores decreased from 6.09 preoperatively to 1.95 postoperatively, he noted. – by Robert Linnehan

Reference:
Yoon BV. Paper #S2.13. Presented at: Philadelphia Spine Research Symposium; Nov. 9-12, 2015; Philadelphia.

For more information:

Andrew A. Sama, MD, and B. Victor Yoon, MS, can be reached at Hospital for Special Surgery, 535 E. 70th St., New York, NY 10021; emails: samaa@hss.edu and yoonb@hss.edu.

Disclosures: Sama and Yoon report no relevant financial disclosures.