Allograft Versus Demineralized Bone Matrix in Instrumented and Noninstrumented Lumbar Fusion: A Systematic Review. Issue 4 (June 2018)

• Record Type: Journal Article
• Authors: Buser, Zorica; Brodke, Darrel S.; Youssef, Jim A.; Rometsch, Elke; Park, Jong-Beom; Yoon, S. Tim; Wang, Jeffrey C.; Meisel, Hans-Joerg
• Is Part Of: Global spine journal. Volume 8:Issue 4(2018)
• Page Start: 396
• Page End: 412
• Publication Date: 2018-06
• Subjects: systematic review -- lumbar spine -- spinal fusion -- allograft -- demineralized bone matrix -- autograft; Spine -- Diseases -- Periodicals; Spine -- Diseases -- Treatment -- Periodicals; Spine -- Abnormalities -- Periodicals; Spine -- Surgery -- Periodicals; 616.73
• DOI: 10.1177/2192568217735342
• Languages: English
• ISSNs: 2192-5682

Abstract

Study Design: Systematic review. Objectives: The aim was to determine the fusion efficacy of allograft and demineralized bone matrix (DBM) in lumbar instrumented and noninstrumented fusion procedures for degenerative lumbar disorders. Methods: A literature search was conducted using the PubMed and Cochrane databases. To be considered, publications had to meet 4 criteria: patients were treated for a degenerative lumbar disorder, a minimum group size of 10 patients, use of allograft or DBM, and at least a 2-year follow-up. Data on the study population, follow-up time, surgery type, grafting material, fusion rates, and its definition were collected. Results: The search yielded 692 citations with 17 studies meeting the criteria including 4 retrospective and 13 prospective studies. Six studies used DBM and 11 employed allograft alone or in the combination with autograft. For the allograft, fusion rates ranged from 58% to 68% for noninstrumented and from 68% to 98% for instrumented procedures. For DBM, fusion rates were 83% for noninstrumented and between 60% and 100% for instrumented lumbar fusion procedures. Conclusions: Both allograft and DBM appeared to provide similar fusion rates in instrumented fusions. On the other hand, in noninstrumented procedures DBM was superior. However, a large variation in the type of surgery, outcomes collection, lack of control groups, and follow-up time prevented any significant conclusions. Thus, studies comparing the performance of allograft and DBM to adequate controls in large, well-defined patient populations and with a sufficient follow-up time are needed to establish the efficacy of these materials as adjuncts to fusion.