Skip to main content
SpringerLink
Log in

A comparison of commercially available demineralized bone matrix for spinal fusion

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

In an effort to augment the available grafting material as well as to increase spinal fusion rates, the utilization of a demineralized bone matrix (DBM) as a graft extender or replacement is common. There are several commercially available DBM substances available for use in spinal surgery, each with different amounts of DBM containing osteoinductive proteins. Each product may have different osteoinductivity potential due to different methods of preparation, storage, and donor specifications. The purpose of this study is to prospectively compare the osteoinductive potential of three different commercially available DBM substances in an athymic rodent spinal fusion model and to discuss the reasons of the variability in osteoinductivity. A posterolateral fusion was performed in 72 mature athymic nude female rats. Three groups of 18 rats were implanted with 1 of 3 DBMs (Osteofil, Grafton, and Dynagraft). A fourth group was implanted with rodent autogenous iliac crest bone graft. The rats were sacrificed at 2, 4, 6, and 8 weeks. A dose of 0.3 cm3 per side (0.6 cm3per animal) was used for each substance. Radiographs were taken at 2 weeks intervals until sacrifice. Fusion was determined by radiographs, manual palpation, and histological analysis. The Osteofil substance had the highest overall fusion rate (14/18), and the highest early 4 weeks fusion rate of (4/5). Grafton produced slightly lower fusion rates of (11/17) overall, and lower early 4 weeks fusion rate of (2/5). There was no statistically significant difference between the rate of fusion after implantation of Osteofil and Grafton. None of the sites implanted with Dynagraft fused at any time point (0/17), and there was a significantly lower fusion rate between the Dynagraft and the other two substances at the six-week-time point and for final fusion rate (P = 0.0001, Fischer’s exact test). None of the autogenous iliac crest animals fused at any time point. Non-decalcified histology confirmed the presence of a pseudarthrosis or the presence of a solid fusion, and the results were highly correlated with the manual testing. Although all products claim to have significant osteoinductive capabilities, this study demonstrates that there are significant differences between some of the tested products.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Becerra J, Andrades JA, Ertl DC, Sorgente N, Nimni ME (1996) Demineralized bone matrix mediates differentiation of bone marrow stromal cells in vitro: effect of age of cell donor. J Bone Miner Res 11:1703–1714

    Article  PubMed  CAS  Google Scholar 

  2. Boyce T, Edwards J, Scarborough N (1999) Allograft bone. The influence of processing on safety and performance. Orthop Clin North Am 30:571–581

    Article  PubMed  CAS  Google Scholar 

  3. Chesmel KD, Branger J, Wertheim H, Scarborough N (1998) Healing response to various forms of human demineralized bone matrix in athymic rat cranial defects. J Oral Maxillofac Surg 56:857–863

    Article  PubMed  CAS  Google Scholar 

  4. Cobos JA, Lindsey RW, Gugala Z (2000) The cylindrical titanium mesh cage for treatment of a long bone segmental defect: description of a new technique and report of two cases. J Orthop Trauma 14:54–59

    Article  PubMed  CAS  Google Scholar 

  5. Edwards JT, Diegmann MH, Scarborough NL (1998) Osteoinduction of human demineralized bone: characterization in a rat model. Clin Orthop Relat Res 357:219–228

    Article  PubMed  Google Scholar 

  6. Grauer JN, Bomback DA, Lugo R, Troiano NW, Patel TC, Friedlander GE (2004) Posterolateral lumbar fusions in athymic rats: characterization of a model. Spine J4:281–286

    Google Scholar 

  7. Han B, Tang B, Nimni M (2003) Quantitative and sensitive in vitro assay for osteoinductive activity of demineralized bone matrix. J Orthop Res 21:648–654

    Article  PubMed  CAS  Google Scholar 

  8. Kado KE, Gambetta LA, Perlman MD (1996) Uses of grafton for reconstructive foot and ankle surgery. J Foot Ankle Surg 5:59–66

    Article  Google Scholar 

  9. Lee YP, Jo M, Luna M, Chien B, Lieberman JR, Wang JC (2005) The efficacy of different commercially available demineralized bone matrix substances in an athymic rat model. J Spinal Disord Tech Oct 18(5):439–444

    Article  Google Scholar 

  10. Lomas RJ, Gillan HL, Matthews JB, Ingham E, Kearney JN (2001) An evaluation of the capacity of differently prepared demineralised bone matrices (DBM) and toxic residuals of ethylene oxide (EtOx) to provoke an inflammatory response in vitro. Biomaterials 22:913–921

    Article  PubMed  CAS  Google Scholar 

  11. Martin GJ Jr, Boden SD, Titus L, Scarborough NL (1999) New formulations of demineralized bone matrix as a more effective graft alternative in experimental posterolateral lumbar spine arthrodesis. Spine 24:637–645

    Article  PubMed  Google Scholar 

  12. Morone MA, Boden SD (1998) Experimental posterolateral lumbar spine fusion with a demineralized bone matrix gel. Spine 23:159–167

    Article  PubMed  CAS  Google Scholar 

  13. Nishimoto SK, Chang CK, Gendler E, Stryker WF, Nimni ME (1996) The effect of aging on bone formation in rats: biochemical and histological evidence for decreased bone formation capacity. Calcif Tissue Int 37:617–624

    Article  Google Scholar 

  14. Peterson B, Whang PG, Iglesias R, Wang JC, Lieberman RJ (2004) Osteoinductivity of commercially available demineralized bone matrix. Preparations in a spine fusion model. J Bone J Surg (2004) 86:2243–2250

    Google Scholar 

  15. Reddi AH, Huggins CB (1973) Influence of geometry of transplanted tooth and bone on transformation of fibroblasts. Proc Soc Exp Biol Med 143:634–647

    PubMed  CAS  Google Scholar 

  16. Russell J, Scarborough N, Chesmel K (1997) Re: ability of commercial demineralized freeze-dried bone allograft to induce new bone formation (1996; 67:918–26) [letter; comment]. J Periodontol 68:804–806

    PubMed  CAS  Google Scholar 

  17. Russell JL, Block JE (1999) Clinical utility of demineralized bone matrix for osseous defects, arthrodesis, and reconstruction: impact of processing techniques and study methodology. Orthopedics 22:524–531

    PubMed  CAS  Google Scholar 

  18. Sampath TK, Reddi AH (1984) Importance of geometry of the extracellular matrix in endochondral bone differentiation. J Cell Biol 98:2192–2197

    Article  PubMed  CAS  Google Scholar 

  19. Scarborough NL, White EM, Hughes JV, Manrique AJ, Poser JW (1995) Allograft safety: viral inactivation with bone demineralization. Contemp Orthop 31:257–261

    PubMed  CAS  Google Scholar 

  20. Silber JS, Anderson DG, Daffner SD, Brislin BT, Leland JM, Hilibrand AS, Vaccaro AR, Albert TJ (2003) Donor site morbidity after anterior iliac crest bone harvest for single-level anterior cervical discectomy and fusion. Spine 28:134–139

    Article  PubMed  Google Scholar 

  21. Takikawa S, Bauer TW, Kambic H, Togawa D (2003) Comparative evaluation of the osteoinductivity of two formulations of human demineralized bone matrix. J Bone Miner Res 65(1):37–42

    Google Scholar 

  22. Traianedes K, Russell JL, Edwards JT, Stubbs HA, Shanahan IR, Knaack D (2004) Donor age and gender effects on osteoinductivity of demineralized bone matrix. J Biomed Mater Res B Appl Biomater 70:21–29

    Article  PubMed  CAS  Google Scholar 

  23. Urist MR, Dowell TA (1968) Inductive substratum for osteogenesis in pellets of particulate bone matrix. Clin Orthop 61:61–78

    PubMed  CAS  Google Scholar 

  24. Wang JC, Yoo S, Kanim EAL, Campbell PA, Berk A, Lieberman JA (2003) Effect of regional gene therapy with bone morphogenetic protein -2-producing bone marrow cells on spinal fusion in rats. J Bone Joint Surg 85A:905–911

    Google Scholar 

  25. Wientroub S, Reddi AH (1988) Influence of irradiation on the osteoinductive potential of demineralized bone matrix. Calcif Tissue Int 42:255–260

    Article  PubMed  CAS  Google Scholar 

  26. Yazdi M, Bernick S, Paule WJ, Nimni ME (1991) Postmortem degradation of demineralized bone matrix osteoinductive potential. Effect of time and storage temperature. Clin Orthop 262:281–285

    PubMed  Google Scholar 

  27. Younger EM, Chapman MW (1989) Morbidity at bone graft donor sites. J Orthop Trauma 3:192–195

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, UCLA School of Medicine, Los Angeles, CA, 90024, USA

    Jeffrey C. Wang, A. Alanay, Davies Mark, Linda E. A. Kanim, Pat A. Campbell, Edgar G. Dawson & Jay R. Lieberman

  2. Department of Orthopaedics and Traumatology, UCLA School of Medicine, Los Angeles, CA, 90024, USA

    A. Alanay

Authors
  1. Jeffrey C. Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Alanay
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Davies Mark
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Linda E. A. Kanim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pat A. Campbell
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Edgar G. Dawson
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jay R. Lieberman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Alanay.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wang, J.C., Alanay, A., Mark, D. et al. A comparison of commercially available demineralized bone matrix for spinal fusion. Eur Spine J 16, 1233–1240 (2007). https://doi.org/10.1007/s00586-006-0282-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-006-0282-x

Keywords

Search

Navigation