![]() ![]() ![]() This chapter reviews the key basic science principles, preclinical studies, and clinical studies that guide the surgeon in the appropriate use of biologics in the cervical spine.įor successful spinal fusion to occur, sufficient bone graft, adequate vascularity to the fusion bed, and mechanical stability of the fusion levels are required. Each of these biologics has different characteristics and different degrees of osteoconductivity, osteoinductivity, and ostegenicity. The biologics include demineralized bone matrix (DBM), ceramics, allografts containing mesenchymal stem cells, and growth factors. Historically, allograft and autograft bone have been the mainstays of cervical fusion however, in more recent years, surgeons have begun using a class of bone graft substitutes known as biologics. ![]() Surgical fusion of the cervical spine is a common procedure with a myriad of indications. Specifically, the use of recombinant human BMP-2 (rhBMP-2) in the cervical spine remains debated the optimal concentration, carrier system, and associated complications continue to be investigated. Knowledge and understanding of the use of BMP in the cervical continue to evolve BMPs should be used carefully because potential complications remain unknown. The quantity and quality of mesenchymal cells available in allograft containing mesenchymal stem cells are unknown. In single-level anterior cervical diskectomy and fusion, allograft bone is highly effective with similar fusion rates as compared to autograft boneĭBM allows for natural bone morphogenetic proteins (BMPs) to become available to induce bone formation.Ĭeramics are synthetic bone grafts consisting of calcium phosphate biomaterials fused into an osteoconductive structure.īMPs are multifunctional growth factors that belong to the transforming growth factor-β superfamily and have variable osteoinductive properties.ĭBM has no structural support and must be used with a cage or as a graft enhancer.Ĭeramics are brittle and have low impact and fracture resistance. The most common traditional bone graft is autograft, typically harvested from the iliac crest. Graft materials can also be classified based on their ability to serve as graft extenders, enhancers, or bone graft substitutes. Unlike posterior cervical spine surgery, bone graft requirements for anterior cervical surgery include the ability for the graft structurally to resist axial compression.Įach graft material differs in properties providing a supply of osteogenic cells, an osteoconductive matrix, and an osteoinductive signal. This chapter reviews the key basic science principles, preclinical studies, and clinical studies that guide the surgeon in the appropriate use of biologics in the cervical spine.Ī successful spinal fusion requires sufficient bone graft, adequate vascularity to the fusion bed, and mechanical stability at the fusion level. Screws and rods are placed into the vertebrae to support the graft and promote the fusion of the vertebrae.Biologics in cervical spine surgery include demineralized bone matrix (DBM), ceramics, allografts containing mesenchymal stem cells, and growth factors.Following laminectomy, the bone graft (small chips of bone) will be placed between the vertebrae.The roof of the vertebra will be trimmed or removed to relieve pressure on the nerve. During the surgery, your surgeon performs a discectomy, where a portion of the diseased or damaged disc material is removed.Your surgeon may approach your spine from the back, abdomen or neck, depending on the area to be treated.Lumbar fusion can be performed as an open or laparoscopic (keyhole) surgery.Lumbar fusion surgery may be performed to treat spondylolisthesis (slipping of the spine bones), degenerated discs, scoliosis or kyphosis (abnormal curvature of the spine), spinal infections or tumors, traumatic injury of the spine, recurrent disc herniation and unstable spine. Screws, plates, or cages may be used with the bone graft to help hold the spine. ![]() A piece of bone, taken from other parts of the body or donated from a bone bank is transplanted between the adjacent vertebrae. Lumbar fusion is the procedure of fusing the vertebrae in the lumbar portion of the spine (lower back). Spinal fusion, also called arthrodesis, is a surgical technique used to join two or more vertebrae (bones) within the spine. ![]()
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