title: Bone graft substitutes for anterior lumbar interbody fusion.
abstract: The procedure of anterior lumbar interbody fusion (ALIF) is commonly performed on patients suffering from pain and/or neurological symptoms associated with disorders of the lumbar spine caused by disc degeneration and trauma. Surgery is indicated when prolonged conservative management proves ineffective. Because an important objective of the ALIF procedure is solid arthrodesis of the degenerative spinal segment, bone graft selection is critical. Iliac crest bone grafts (ICBG) remain the "gold standard" for achieving lumbar fusion. However, patient dissatisfaction stemming from donor site morbidity, lengthier operating times and finite supply of ICBG has prompted a search for better alternatives. Here presented is a literature review evaluating available bone graft options assessed within the clinical setting. These options include autografts, allograft-based, synthetic and cell-based technologies. The emphasis is on the contentious use of recombinant human bone morphogenetic proteins, which is in widespread use and has demonstrated both significant osteogenic potential and risk of complications.
authors: Neuro Spine Clinic, Prince of Wales Private Hospital, Randwick, Australia. ralphmobbs@hotmail.com
authors: Ralph J
authors: RJ
authors: Mobbs
authors: Mina
authors: M
authors: Chung
authors: Prashanth J
authors: PJ
authors: Rao
mesh_terms: D019485:Bone Morphogenetic Proteins / Q000627:therapeutic use; D018786:Bone Substitutes / Q000627:therapeutic use*; D016025:Bone Transplantation / Q000379:methods*; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D011994:Recombinant Proteins / Q000627:therapeutic use; D013123:Spinal Fusion / Q000379:methods*
chemical_list: D019485:Bone Morphogenetic Proteins; D018786:Bone Substitutes; D011994:Recombinant Proteins
references: J Spinal Disord. 1998 Oct;11(5):375-82
references: 9811096
references: Spine J. 2002 Jan-Feb;2(1):63-9
references: 14588290
references: Spine J. 2007 May-Jun;7(3):301-7
references: 17482113
references: Eur Spine J. 2006 Jan;15(1):16-22
references: 15843972
references: Eur Spine J. 2001 Jun;10(3):237-41
references: 11469736
references: Bone. 1999 Jul;25(1):25-32
references: 10423018
references: Spine (Phila Pa 1976). 2003 Feb 15;28(4):372-7
references: 12590213
references: J Spinal Disord. 2001 Apr;14(2):91-9
references: 11285419
references: J Bone Joint Surg Am. 1972 Jun;54(4):756-68
references: 4560076
references: World Neurosurg. 2010 May;73(5):565-71
references: 20920944
references: Spine (Phila Pa 1976). 1989 Aug;14(8):876-8
references: 2781400
references: J Bone Joint Surg Am. 1979 Dec;61(8):1143-50
references: 389928
references: Neurol Med Chir (Tokyo). 2010;50(8):645-50
references: 20805646
references: J Neurosurg Spine. 2009 Jun;10(6):610-6
references: 19558296
references: Orthop Clin North Am. 1999 Oct;30(4):543-52
references: 10471759
references: Arch Orthop Trauma Surg. 2012 Dec;132(12):1725-40
references: 22941273
references: Spine (Phila Pa 1976). 2004 Sep 1;29(17):1893-9; discussion 1900
references: 15534411
references: Clin Orthop Relat Res. 1996 Mar;(324):75-85
references: 8595780
references: Spine (Phila Pa 1976). 2009 Feb 1;34(3):238-43
references: 19179918
references: Neurosurgery. 2008 May;62(5 Suppl 2):ONS423-31; discussion ONS431
references: 18596525
references: Spine (Phila Pa 1976). 2002 Aug 15;27(16 Suppl 1):S2-8
references: 12205411
references: Spine (Phila Pa 1976). 2002 Aug 15;27(16 Suppl 1):S94-9
references: 12205426
references: Eur Spine J. 1994;3(4):225-30
references: 7866841
references: Eur Spine J. 2004 Aug;13(5):425-31
references: 15138863
references: J Bone Joint Surg Am. 2009 May;91(5):1181-9
references: 19411467
references: SAS J. 2010 Sep 01;4(3):75-86
references: 25802654
references: J Orthop Sci. 2011 Jul;16(4):352-8
references: 21567233
references: Injury. 2011 Sep;42 Suppl 2:S3-15
references: 21704997
references: Spine (Phila Pa 1976). 1995 Oct 15;20(20):2211-6
references: 8545714
references: Pharmacoepidemiol Drug Saf. 2011 Feb;20(2):111-8
references: 21254281
references: J Neurosurg. 2000 Oct;93(2 Suppl):259-65
references: 11012057
references: J Bone Joint Surg Am. 2010 Nov 3;92(15):2614-5; author reply 2615-6
references: 21048181
references: Eur Spine J. 1998;7(2):125-31
references: 9629936
references: Clin Orthop Relat Res. 1982 May;(165):157-63
references: 7042161
references: J Bone Joint Surg Br. 1971 Nov;53(4):617-27
references: 5131814
references: Spine (Phila Pa 1976). 2010 Apr 20;35(9 Suppl):S86-104
references: 20407355
references: Spine (Phila Pa 1976). 2000 Feb 1;25(3):376-81
references: 10703113
references: Spine (Phila Pa 1976). 2002 Dec 15;27(24):E518-25; discussion E526-7
references: 12486360
references: SAS J. 2008 Jun 01;2(2):62-8
references: 25802604
references: Spine (Phila Pa 1976). 2004 Jan 15;29(2):113-22; discussion 121-2
references: 14722400
references: Eur Spine J. 2006 Sep;15(9):1352-9
references: 16598484
references: J Spinal Disord Tech. 2012 Oct;25(7):362-9
references: 21716142
references: Clin Orthop Relat Res. 1996 Aug;(329):300-9
references: 8769465
references: Spine (Phila Pa 1976). 1993 Dec;18(16):2393-400
references: 8303439
references: Am J Orthop (Belle Mead NJ). 1995 Dec;24(12):895-903
references: 8776079
references: Spine (Phila Pa 1976). 2006 May 1;31(10):E277-84
references: 16648733
references: J Spinal Disord Tech. 2005 Aug;18(4):347-52
references: 16021016
references: Orthop Clin North Am. 1987 Apr;18(2):235-9
references: 3561975
references: J Spinal Disord Tech. 2005 Feb;18(1):18-22
references: 15687847
references: Eur Spine J. 2005 Feb;14(1):95-8
references: 15365797
references: Spine (Phila Pa 1976). 2006 May 15;31(11):1281-7
references: 16688045
references: Spine (Phila Pa 1976). 2005 Apr 1;30(7):838-43
references: 15803090
references: Spine (Phila Pa 1976). 2012 Sep 15;37(20):1785-9
references: 22472808
references: Spine (Phila Pa 1976). 2002 Nov 1;27(21):2396-408
references: 12438990
references: Spine (Phila Pa 1976). 2008 Sep 15;33(20):2153-9
references: 18725869
references: J Spinal Disord Tech. 2009 Dec;22(8):559-64
references: 19956029
references: Spine J. 2010 Sep;10(9):e1-6
references: 20797648
references: Spine (Phila Pa 1976). 2003 Sep 1;28(17):1968-70; discussion 1971
references: 12973143
references: Spine (Phila Pa 1976). 1988 Mar;13(3):366-9
references: 3291141
references: Spine J. 2003 Mar-Apr;3(2):155-65
references: 14589231
references: J Bone Miner Res. 1995 Nov;10(11):1681-90
references: 8592944
references: Spine (Phila Pa 1976). 2006 Jan 1;31(1):111-4
references: 16395187
references: Spine J. 2010 May;10(5):404-9
references: 20421075
references: Orthopedics. 2003 Oct;26(10):1027-37
references: 14577525
references: Spine J. 2011 Jun;11(6):471-91
references: 21729796
references: Spine J. 2008 May-Jun;8(3):443-8
references: 17526436
references: Eur Spine J. 2009 Apr;18(4):449-64
references: 19152011
references: Spine (Phila Pa 1976). 2001 Dec 15;26(24):2751-6
references: 11740368
references: Clin Orthop Relat Res. 1996 Mar;(324):153-63
references: 8595751
references: Spine J. 2011 Jun;11(6):527-33
references: 20739225
references: Spine (Phila Pa 1976). 1995 Dec 15;20(24 Suppl):113S-123S
references: 8747265
references: Injury. 2009 Dec;40(12):1260-4
references: 19486972
references: J Bone Joint Surg Br. 2007 Mar;89(3):342-5
references: 17356146
references: Spine (Phila Pa 1976). 1998 Jun 1;23(11):1267-78; discussion 1279
references: 9636981
references: Orthopedics. 2002 May;25(5 Suppl):s585-9
references: 12038846
references: J Bone Joint Surg Br. 1989 Aug;71(4):677-80
references: 2768321
references: Spine J. 2011 Jun;11(6):520-1
references: 21612986
references: Eur Spine J. 2011 Aug;20(8):1323-30
references: 21484538
references: Spine (Phila Pa 1976). 2009 May 20;34(12):1251-6
references: 19412139
references: Spine J. 2002 May-Jun;2(3):206-15
references: 14589495
references: Eur Spine J. 2009 May;18(5):687-95
references: 19148687
references: Eur Spine J. 1994;3(1):32-8
references: 7874539
references: Spine (Phila Pa 1976). 2010 Dec 15;35(26):E1564-70
references: 21116214
references: J Spinal Disord Tech. 2002 Oct;15(5):337-49
references: 12394656
references: J Spinal Disord Tech. 2005 Feb;18 Suppl:S77-81
references: 15699810
references: Spine (Phila Pa 1976). 1992 Jul;17(7):831-3
references: 1502649
references: Spine (Phila Pa 1976). 1995 May 1;20(9):1055-60
references: 7631235
references: Clin Orthop Relat Res. 2000 Feb;(371):38-45
references: 10693548
references: Science. 1965 Nov 12;150(3698):893-9
references: 5319761
references: Edinb Med J. 1936 Sep;43(9):545-572
references: 29648170
references: Clin Orthop Relat Res. 1994 Mar;(300):45-51
references: 8131355
references: Spine (Phila Pa 1976). 2003 Jul 1;28(13):1385-9
references: 12838095
references: Spine (Phila Pa 1976). 1988 May;13(5):566-9
references: 3187702
references: Acta Orthop Belg. 2004 Aug;70(4):332-6
references: 15481417
references: Neurosurgery. 2002 Mar;50(3):510-6; discussion 516-7
references: 11841718
references: J Spinal Disord Tech. 2007 Jul;20(5):374-9
references: 17607103