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KMID : 0388720080150010054
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Journal of Korean Society of Spine Surgery
2008 Volume.15 No. 1 p.54 ~ p.65
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Autogenous Bone Graft and Bone Substitutes
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Kim Dong-Jun
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Abstract
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Study Design: Reviews were conducted.
Objectives: This article is a review of the properties of the various bone grafting materials currently available and includes discussion of their efficacy in clinical practice.
Summary of Background Data: Bone grafting is frequently performed in spinal surgery to achieve fusion. Autograft is the gold standard bone graft material. However, due to limitations of supply and morbidity associated with the harvest of autograft, alternatives are being considered.
Methods: The available literature was reviewed.
Results: Synthetic bone graft substitutes consist of hydroxyapatite, tricalcium phosphate, calcium sulfate, or a combination of these minerals. All synthetic porous substitutes share numerous advantages over autografts and allografts including their unlimited supply, easy sterilization, and easy storage. However, they do confer some disadvantages such as brittle handling properties, variable rates of resorption, and poor performance in some clinical conditions. Recent attention has been focused on osteoinductive materials such as demineralized bone matrix, recombinant bone morphogenetic proteins, and blood product concentrates. The primary categories of substitute include bone growth factors. Clinical trials are under way, and pre-clinical studies have reported promising results for generating bone.
Conclusions: Despite tremendous efforts toward developing autograft alternatives, a single ideal bone graft substitute has not been developed. The number of clinical studies and direct-comparison studies between these products is limited. The surgeon should understand the properties of each bone graft substitute, to facilitate appropriate selection in each specific clinical situation.
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KEYWORD
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Bone graft, Bone substitutes
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