The effectiveness of rhBMP-2 in replacing autograft: an integrated analysis of three human spine studies.

In anterior lumbar spinal fusion, patients treated with rhBMP-2 on a collagen sponge carrier had statistically superior outcomes compared to patients treated with autogenous bone graft. A collagen sponge carrier should replace autogenous bone graft for this patient population.

A cost analysis of bone morphogenetic protein versus autogenous iliac crest bone graft in single-level anterior lumbar fusion.

An economic model was developed to compare costs of stand-alone anterior lumbar interbody fusion with recombinant human bone morphogenetic protein 2 on an absorbable collagen sponge versus autogenous iliac crest bone graft in a tapered cylindrical cage or a threaded cortical bone dowel. The economic model was developed from clinical trial data, peer-reviewed literature, and clinical expert opinion. The upfront price of bone morphogenetic protein (3380 dollars) is likely to be offset to a significant extent by reductions in the use of other medical resources, particularly if costs incurred during the 2 year period following the index hospitalization are taken into account.

Is INFUSE bone graft superior to autograft bone? An integrated analysis of clinical trials using the LT-CAGE lumbar tapered fusion device.

Multicenter human clinical studies of patients undergoing anterior lumbar fusion have been conducted using recombinant bone morphogenetic protein or rhBMP-2 on an absorbable collagen sponge, marketed as INFUSE Bone Graft, or autograft implanted in the LT-CAGE Lumbar Tapered Fusion device. An integrated analysis of multiple clinical studies was performed using an analysis of covariance to adjust for preoperative variables in a total of 679 patients. Of these patients, 277 had their cages implanted with rhBMP-2 on an absorbable collagen sponge and 402 received autograft transferred from the iliac crest.

Laparoscopic approaches to fusion of the lumbosacral spine: latest techniques.

The particular advantages of interbody cages include the beneficial effects on bone healing associated with the anterior column location (Wolff's Law), the stabilization potential in appropriate motion segments, the ability to restore anterior column height and foraminal volume, and the avoidance of the fusion disease phenomenon. These advantages do not depend on whether the approach of insertion is open or laparoscopic. The specific and demonstrated chief benefit of the laparoscopic approach to interbody cage insertion is the reduction in surgical morbidity.

Complications and strategies for salvage of intervertebral fixation devices.

The recent evolution of interbody fixation devices, known as threaded interbody fusion cages, is a significant new form of segmental fixation for application to the lumbar and lumbosacral spine. This article discusses the construction, biomechanics, and use of these devices, which serve as carriers for autogenous graft material while restoring segmental stability to the involved motion segment. The biomechanics of these devices greatly surpasses those of the interbody spacers used historically.