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The Journal of Bone and Joint Surgery, Vol 77, Issue 9 1404-1417, Copyright © 1995 by Journal of Bone and Joint Surgery, Inc
Lumbar intertransverse-process spinal arthrodesis with use of a bovine bone-derived osteoinductive protein. A preliminary report
SD Boden, JH Schimandle and WC Hutton
Department of Orthopaedic Surgery, Emory Spine Center, Emory University School of Medicine, Decatur, Georgia 30033, USA.
The use of a bovine bone-derived osteoinductive protein extract as a
bone-graft substitute was evaluated in a rabbit model of intertransverse
process arthrodesis of the lumbar spine. Forty-five adult New Zealand White
rabbits had arthrodesis between the fifth and sixth lumbar vertebrae with
use of one of three graft materials: autogenous iliac-crest bone,
osteoinductive protein delivered in an allogeneic demineralized bone
matrix/collagen carrier, or demineralized bone matrix/collagen carrier or
demineralized bone matrix/collagen carrier without osteoinductive protein.
Fusion was assessed by manual palpation, radiography, biomechanical
testing, and light microscopy at two and five weeks after the operation. At
two weeks, light microscopic analysis of the arthrodesis site in which
osteoinductive protein had been used showed that most of the demineralized
bone matrix was still present, with small amounts of membranous and
endochondral bone formation at the peripheral margins of the implant. Light
microscopic analysis of the five-week specimens showed increased new-bone
formation and a more homogeneous and mature fusion mass with the
osteoinductive bone protein than with the autogenous bone graft. At five
weeks, the fusions with the osteoinductive protein extract were
characterized by more secondary spongiosa, with formation of bone marrow
centrally and a cortical rim peripherally. Of the thirty-five rabbits that
were examined at five weeks, all ten in the group that had received
osteoinductive bone protein had a solid fusion, but the rate of fusion was
significantly less in the other two groups: eight of thirteen rabbits (p =
0.05) in the group that had received autogenous bone graft and two of
twelve rabbits (p = 0.0001) in the group that had received demineralized
bone matrix/collagen carrier without osteoinductive bone protein. The use
of osteoinductive bone protein resulted in stronger (p = 0.02) and stiffer
(p = 0.005) fusions compared with those obtained with the use of autogenous
iliac-crest graft.
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