Bonus™: DBM with Bone Marrow Aspirate
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Brodke D, Pedrozo HA, Kapur TA, Attawia M, Kraus KH, Holy CE et al. Bone grafts prepared with selective cell retention technology heal canine segmental defects as effectively as autograft. J Orthop Res 2006 May;24(5):857-66.
Summary: A study was done on dogs to determine the efficacy of bone grafting using demineralized bone and cancellous chips (DBM-CC) combined with osteoprogenitor cells obtained by selective cell retention (SCR) technology, and to assess the value of using plateletrich plasma (PRP) to clot the SCR-enriched grafts. The authors determined that SCR-enriched DBM-CC repaired critical-sized bone defects as well as autograft and that PRP may have helped to enhance bone maturation.
Quotation: “Overall radiographic evidence showed that, at 16 weeks, all animals treated with the SCR technology healed, while only 67% of the DBM-CC marrow group healed. This fact was confirmed by histological observations that showed more cortical bone formation in the SCRenriched group versus marrow group. Two major conclusions could be drawn from these facts: 1) enriching the osteoprogenitor content of grafts by three-to-four times increased the boneforming potential of DBM-CC; 2) enriched grafts performed similarly to autograft, in this model.
Docquier PL, Delloye C. Treatment of aneurysmal bone cysts by introduction of demineralized bone and autogenous bone marrow. J Bone Joint Surg Am 2005 October;87(10):2253-8.
Summary: A paste of demineralized bone and autologous bone marrow was introduced into primary aneurysmal bone cysts in 13 patients. After a mean follow-up time of 3.9 years, healing was achieved in 11 patients. The authors believe that this method of treating bone cysts promotes self-healing without extensive surgery or blood loss.
Quotation: “Our results encourage the further use of this minimally invasive method for the treatment of primary aneurysmal bone cysts. Its major advantage is to promote healing of the cyst without extensive surgery. As it is minimally invasive, it decreases the risk of infection and offers potential advantages for the treatment of cysts in poorly accessible locations such as the pelvis or spine, although we have no experience with spinal lesions…. We believe that this method may offer several advantages for the patient and surgeon and that it is worth considering as an option for the treatment of an aneurysmal bone cyst.”
Rougraff BT, Kling TJ. Treatment of active unicameral bone cysts with percutaneous injection of demineralized bone matrix and autogenous bone marrow. J Bone Joint Surg 2002 June;84- A(6):921-929.
Summary: A mixture of demineralized bone matrix (DBM) and bone marrow was injected into trephinated active unicameral bone cysts in 23 patients. After an average follow-up of 50 months, patients demonstrated relief of pain, return to unrestricted activity, and radiographic evidence of cortical remodeling. There was no increase in the size of the cysts or occurrence of fracture during the course of the treatment. The authors concluded that this method is effective for the treatment of bone cysts.
Quotation: “Our goal of treating unicameral bone cysts was to relieve pain and prevent pathologic fracture. These goals were achieved with one injection in 78% of patients and with two injections in all patients. We did not observe any fractures of non-enlarging lytic bone defects associated with incomplete bone-healing following treatment. There were no late recurrences of any of the cysts.”
Muschler GF, Matsukura Y, Nitto H, Boehm CA, Valdevit AD, Kambic HE et al. Selective retention of bone marrow-derived cells to enhance spinal fusion. Clin Orthop Relat Res 2005 March;(432):242-51.
Summary: In a canine spinal fusion model, demineralized bone matrix (DBM) alone was compared with DBM mixed with bone marrow and DBM mixed with osteoprogenitor cells concentrated by selective retention. Outcomes that were measured included union score, fusion mass, fusion volume, and mechanical testing. The DBM mixed with concentrated progenitor cells produced a better union score, fusion mass, and fusion volume than either DBM alone or DBM mixed with marrow. The authors concluded that concentrating progenitor cells may improve the results of bone grafting procedures.
Quotation: “Moreover, these data also support the hypothesis, and our previous observation, that the efficacy of a graft can be increased through preparation of an enriched composite of marrow cells, using the surface of the matrix as a means of selectively attaching and retaining marrowderived cells and connective tissue progenitors for transplantation into a graft site. Enrichment of the matrix in this way resulted in increases in union score, fusion area, and fusion volume beyond those achieved by using a bone marrow aspirate alone. This enriched matrix was far superior to the allograft matrix alone.”
Connolly JF. Injectable bone marrow preparations to stimulate osteogenic repair. Clin Orthop Relat Res 1995 April;(313):8-18.
Summary: This article reviews various preparations of bone marrow which are used to repair bone defects, nonunions, fractures, etc. Preparations of marrow that are discussed include marrow, concentrated osteoprogenitor cells, and mixtures of marrow or concentrated progenitor cells with grafting materials such as demineralized bone matrix.
Quotation: “These results indicate a consistent osteogenic response to this composite graft in 90% of patients, similar to the observed response with open autologous bone graftings that have been standard for >50 years. The composite graft avoids morbidity at the donor site and frequently at the recipient site.”
Tiedeman JJ, Garvin KL, Kile TA, Connolly JF. The role of a composite, demineralized bone matrix and bone marrow in the treatment of osseous defects. Orthopedics 1995 December;18(12):1153-8.
Summary: DBM was used alone and with bone marrow to treat bone defects in 48 patients. After an average of 19 months, a 77% success rate was achieved in healing bone defects. The most difficult defect to heal was fracture nonunion, which demonstrated a 61% success rate. The authors concluded that the DBM and bone marrow composite could be used as a substitute to autologous iliac crest graft in certain clinical situations.
Quotation: “In conclusion, this study demonstrates the effectiveness of DBM as a graft material, used alone and in combination with autologous bone marrow, to treat a variety of osseous defects. The healing that results after DBM and bone marrow composite grafting is comparable to that generally achieved with autologous cortico-cancellous bone.”
Tiedeman JJ, Connolly JF, Strates BS, Lippiello L. Treatment of nonunion by percutaneous injection of bone marrow and demineralized bone matrix. An experimental study in dogs. Clin Orthop Relat Res 1991 July;(268):294-302.
Summary: 6-mm segmental defects were created in dogs and later injected with saline, DBM powder, autogeneic marrow, DBM powder plus marrow, or treated by standard open grafting with autogeneic cancellous bone. Although both DBM powder and marrow stimulated healing when used separately, the combination of DBM and marrow produced better healing than either one alone. The authors conclude that percutaneous injection of DBM and marrow may be an alternative treatment for fracture nonunions.
Quotation: “This animal study supports the effectiveness of injecting composite grafts to heal skeletal defects and nonunions. A composite graft of autogeneic marrow and DBM was at least equal, if not superior, to standard open, operative, grafting techniques.”
Lindsey RW, Wood GW, Sasasivian KK, Stubbs HA, Block JE. Grafting long bone fractures with demineralized bone matrix putty enriched with bone marrow: pilot findings. Orthopedics 2006 October;29(10):939-941.
Summary: In a study of 18 patients, a mixture of demineralized bone matrix (DBM) and bone marrow aspirate (BMA) was compared to autograft in the repair of long bone fractures. After a period of 24 months, all ten DBM/BMA patients were considered to be healed at final follow-up, compared to 5 of 8 (63%)of autograft patients. The authors concluded that a DBM/BMA mixture may be able to be used instead of autograft in long bone fracture repair.
Quotation: "The findings of this pilot study suggest that a composite of DBM putty and aspirated bone marrow offers comparable results to autograft when used to treat long bone fractures."