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      Use of Carboxymethyl Cellulose and Collagen Carrier with Equine Bone Lyophilisate Suggests Late Onset Bone Regenerative Effect in a Humerus Drill Defect – A Pilot Study in Six Sheep

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          Abstract

          We assessed the use of a filler compound together with the osteoinductive demineralized bone matrix (DBM), Colloss E. The filler was comprised of carboxymethyl-cellulose and collagen type 1. The purpose of the study was to see if the filler compound would enhance the bone formation and distribute the osteoinductive stimulus throughout the bone defect. Six sheep underwent a bilateral humerus drill defect. The drill hole was filled with a compound consisting of 100 mg CMC, 100 mg collagen powder, and 1 ccm autologous full blood in one side, and a combination of this filler compound and 20 mg Colloss E in the other. The animals were divided into three groups of two animals and observed for 8, 12 and 16 weeks. Drill holes was evaluated using quantitative computed tomography (QCT), micro computed tomography (µCT) and histomorphometry. Mean total bone mineral density (BMD) of each implantation site was calculated with both QCT and µCT. Bone volume to total volume (BV/TV) was analyzed using µCT and histomorphometry. Although not statistically significant, results showed increased bone BMD after 16 weeks in µCT data and an increased BV/TV after 16 weeks in both µCT and histology. Correlation between QCT and µCT was R 2 = 0.804. Correlation between histomorphometry and µCT BV/TV data was R 2 = 0.8935 and with an average overrepresentation of 8.2% in histomorphometry. In conclusion the CMC-Collagen + Colloss E filler seems like a viable osteogenic bone filler mid- to long term. A correlation was found between the analytical methods used in this study.

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          Most cited references29

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          Anterior lumbar interbody fusion using rhBMP-2 with tapered interbody cages.

          In a multicenter, prospective, randomized, nonblinded, 2-year study, 279 patients with degenerative lumbar disc disease were randomly divided into two groups that underwent interbody fusion using two tapered threaded fusion cages. The investigational group (143 patients) received rhBMP-2 on an absorbable collagen sponge, and a control group (136 patients) received autogenous iliac crest bone graft. Plain radiographs and computed tomographic scans were used to evaluate fusion at 6, 12, and 24 months after surgery. Mean operative time (1.6 hours) and blood loss (109.8 mL) were less in the investigational rhBMP-2 group than in the autograft control group (2.0 hours and 153.1 mL). At 24 months the investigational group's fusion rate (94.5%) remained higher than that of the control group (88.7%). New bone formation occurred in all investigational patients. At all intervals, mean postoperative Oswestry, back pain, and leg pain scores and neurologic status improved in both treatment groups with similar outcomes. In the control group, eight adverse events related to the iliac crest graft harvest occurred (5.9%), and at 24 months 32% of patients reported graft site discomfort and 16% were bothered by its appearance. Lumbar fusion using rhBMP-2 and a tapered titanium fusion cage can yield a solid union and eliminate the need for harvesting iliac crest bone graft.
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            Increased swelling complications associated with off-label usage of rhBMP-2 in the anterior cervical spine.

            Independent, retrospective clinical record review with a concurrent control. To identify whether rhBMP-2 is associated with an increased incidence of clinically relevant postoperative prevertebral swelling problems in patients undergoing anterior cervical fusions. Bone Morphogenetic Protein-2 (rhBMP-2) is FDA approved as a bone graft substitute in anterior lumbar interbody fusions. rhBMP-2 has also been used "off-label" in anterior cervical fusions. We suspected that rhBMP-2 might increase the incidence of adverse swelling events. A total of 234 consecutive patients (ages 12-82 years) undergoing anterior cervical fusion with and without rhBMP-2 over a 2-year period at one institution comprised the study population. The incidence of clinically relevant prevertebral swelling was calculated. The populations were compared and statistical significance was determined. A total of 234 patients met the study criteria, 69 of whom underwent anterior cervical spine fusions using rhBMP-2; 27.5% of those patients in the rhBMP-2 group had a clinically significant swelling event versus only 3.6% of patients in the non-rhBMP-2 group. This difference was statistically significant (P < 0.0001) and remained so after controlling for other significant predictors of swelling. Off-label use of rhBMP-2 in the anterior cervical spine is associated with an increased rate of clinically relevant swelling events.
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              Chronic donor site pain complicating bone graft harvesting from the posterior iliac crest for spinal fusion.

              To explore the relationship between surgical approach and chronic posterior iliac crest donor site pain, 151 bone graft harvests with follow-up periods longer than 1 year were evaluated using a detailed questionnaire and follow-up clinical visits. There was no difference in the incidence of chronic donor site pain between harvests performed through the primary midline incision versus a separate lateral oblique incision (28 vs 31%). Twice as many donor sites harvested for reconstructive spinal procedures were reported as having chronic pain as compared with those harvested for spinal trauma, regardless of approach used (39 vs 18%). The association of chronic donor site pain with residual back pain was also greater in the spinal reconstructive group. Thus, it appears that incidence of chronic donor site pain is more dependent on diagnosis than on surgical approach.
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                Author and article information

                Journal
                Open Orthop J
                TOORTHJ
                The Open Orthopaedics Journal
                Bentham Open
                1874-3250
                11 May 2010
                2010
                : 4
                : 181-187
                Affiliations
                []Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark
                Author notes
                [* ]Address correspondence to this author at the Orthopaedic Research Laboratory, Aarhus University Hospital, Nørrebrogade 44, Building 1A, 8000 Aarhus C, Denmark; Tel: (+45) 20779296; Fax: (+45) 89494150; E-mail: jj@ 123456ki.au.dk
                Article
                TOORTHJ-4-181
                10.2174/1874325001004010181
                2892074
                20582241
                b1daccc9-d6af-4465-8439-a98675adc1ee
                © Jensen et al.; Licensee Bentham Open.

                This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

                History
                : 27 January 2010
                : 17 February 2010
                : 20 March 2010
                Categories
                Article

                Orthopedics
                cellulose.,collagen,histomorphometry,equine bone lyophilisate
                Orthopedics
                cellulose., collagen, histomorphometry, equine bone lyophilisate

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