Reconstruction plate-related complications in mandibular continuity defects
ConclusionReconstruction plates demonstrated a high success rate despite the high complication rate. Segmental defects caused by trauma were smaller than those created after tumor resection and the only factor that increased complication rate was the size of the defect; other factors did not affect the complication rate.
Publication date: December 2019Source: Materials Science and Engineering: C, Volume 105Author(s): Jiancheng Zhang, Da Huang, Shuifeng Liu, Xianming Dong, Yiheng Li, Hongwu Zhang, Zijun Yang, Qisheng Su, Wenhua Huang, Wenxu Zheng, Wuyi ZhouAbstractThe construction of ceramic components with UV curing is a developing trend by an additive manufacturing (AM) technology, due to the excellent advantages of high precision selective fixation and rapid prototyping, the application of this technology to bone defect repair had become one of the hotspots of research. Hydroxyapatite (HAP) is one of the most popular calcium phosphate bi...
Lateral interbody fusion (LLIF) is often performed with biologic adjuvants to promote fusion. Commercially available bone allograft containing allogeneic stem cells (ASC) and bone morphogenetic protein-2 (BMP) are designed to promote fusion while avoiding the morbidity of iliac crest autograft; however, no study to date has directly compared the two in LLIF. The ASC studied is Osteocel Pro (NuVasive, Inc).
Synthetic bone grafts are important tools for spinal surgeons who wish to avoid the invasive harvesting of autologous bone graft for spinal fusions. Various synthetic bone grafts are available on the market, including materials based on bioglass, calcium phosphate or a combination of both. Side-by-side comparisons of synthetic bone grafts in relevant preclinical study models can provide valuable insights that can aid in the selection of treatment options.
Current options for revising screw failure includes larger diameter revisions and/or injecting cement into the vertebral body for secondary screw fixation. An alternative revision method is impaction grafting (pedicoplasty) of the failed pedicle screw track. This technique utilizes impaction of allograft bone into the pedicle and vertebral body through a series of funnels in an attempt to reconstitute a new pedicle.
Iliac crest bone graft (ICBG) has long been considered the gold standard implant for use in spinal fusion procedures. Due to significant donor site morbidity associated with graft harvest, however, use of ICBG has largely been abandoned in favor of other materials. Recombinant human bone morphogenetic protein-2 (rhBMP-2) delivered on an absorbable collagen sponge (ACS; Infuse) is an effective bone graft substitute, but the supra-physiologic doses required to achieve fusion are associated with significant adverse clinical outcomes.
Instrumented posterolateral lumbar fusion (PLF) surgery is commonly used to alleviate pain and other symptoms associated with degenerative conditions of the lumbosacral spine. Although autologous iliac crest bone graft (ICBG) remains the “gold standard” grafting material for these procedures, surgeons have sought alternatives to avoid the potential morbidity associated with ICBG harvest. OSTEOAMP is a novel allograft bone graft substitute (BGS) that has been processed to retain multiple endogenous growth factors.
Achieving spinal fusion requires bone graft and is most reliable using an anterior/posterior technique. Anterior fusion, due to the large bony surface area between the vertebral bodies, results in reliable fusion. Instrumentation which provides stability, also increases the fusion rate. The bone graft for the posterior fusion may come from a variety of sources. Historically, bone graft was obtained from the iliac portion of the patient's own pelvis, IBG, but this may result in additional postoperative pain.
Lumbar spinal fusion is an increasingly common procedure for treating degenerative diseases of the lumbar spine. Non-solid fusion, or pseudarthrosis, at one year is a common complication associated with poor clinical outcomes and need for revision surgery. The risk of pseudarthrosis depends on the number of levels fused, the fusion material, and patient risk factors (osteoporosis, smoking, diabetes, etc.). Although there are multiple options for bone graft and osteoinductive materials, all have their benefits, side-effects and cost.
Lumbar degenerative disc disease contributes to chronic back pain. Mechanisms of intradiscal degeneration have been linked to genetic, metabolic and mechanical imbalance. Symptomatic relief is influenced by meaningful repair of the annulus and by nucleus supplementation.
Approximately 132,000 patients per year undergo anterior cervical discectomy and fusion (ACDF) in the United States. Although the utilization of instrumentation and bone graft alternatives has enhanced fusion rates, pseudarthrosis remains a problem, with incidence rates up to 56%. Renin-angiotensin system (RAS) modulators are typically used to treat arterial hypertension, which affects 50-80% of spinal fusion patients. Recent evidence suggests an association between RAS blockers and bone metabolism, particularly in the context of bone healing.