Surgeon: Understand biologic variabilities for use in adult spinal deformity
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Surgeons should understand the variabilities of biologic categories and how patient and procedure factors may affect use of these in adult spinal deformity, according to a presenter.
Although allografts are the most economical bone graft extender, little data are available on the use of these in patients with adult spinal deformity, according to Wellington K. Hsu, MD.
“There is little difference in price and performance for these products in this category, but there are premium products in this space,” Hsu said in his presentation at the Lumbar Spine Research Society Annual Instructional Course.
Hsu noted demineralized bone matrices (DBM) have variability depending on donor and carrier. Hospitals should demand 100% human tissue products, which are available, and be aware of private labeling, according to Hsu.
When using cell-based matrices, Hsu noted surgeons should consider the mechanism of action and subscribe to how it works. However, he said cell-based matrices do not hold promise compared with other biologics.
“There is little data; there is high cost; there is FDA scrutiny; there are insurance rejections that are increasing over the past couple of years and there has been an industry refocus on this category, in my opinion,” Hsu said.
Comprised of a number of different materials, synthetic carriers are more flexible, less variable and have better biomechanical properties, Hsu noted. Synthetic carriers also have a favorable cost profile and have been shown to have good fusion rates, according to Hsu.
Although bone morphogenetic proteins (BMPs) have good fusion rates, are cost effective and have decreased reoperation rates, Hsu noted studies have shown BMPs have higher complication rates.
“I would advise [surgeons] who are using BMP for adult spinal deformity to be posterolateral only; to avoid posterior interbody use, again this opens up a whole slew of complications that you would not have posterolaterally; and also to use with Mastergraft (Medtronic) because this is not only a good adjunct as a bone graft bulking agent, but also can reduce the extravasation of this protein in areas that you do not want it to be,” Hsu said.
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Hsu WK. The appropriate use of biologics in ASD. Presented at: Lumbar Spine Research Society Annual Instructional Course; Jan. 12, 19, 26, 2021 (virtual meeting).
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