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Augmentation of Rabbit Posterolateral Spondylodesis Using a Novel Demineralized Bone Matrix-Hyaluronan Putty

Juang Ming Yee, Albert, MD*†; Bae, Hyun W., MD*†; Friess, Darin, MD; Robbin, Mark, MD; Johnstone, Brian, PhD*†; Yoo, Jung U., MD*†

doi: 10.1097/01.BRS.0000090828.65638.8C
Basic Science

Study Design. Posterolateral spinal fusion with allogeneic demineralized bone graft–hyaluronan putty in addition to autogenous iliac crest bone graft in a rabbit model.

Objectives. To determine the potential efficacy of demineralized bone graft–hyaluronan putty as a bone graft enhancer.

Summary of Background Data. Autograft bone is the material of choice for posterolateral lumbar intertransverse process fusion. Bone graft alternatives such as demineralized bone matrices that can be used as graft extenders, enhancers, or substitutes continue to be developed.

Methods. One hundred New Zealand white rabbits underwent bilateral posterolateral spinal fusion with autogenous iliac crest bone graft or bone graft with allogeneic rabbit demineralized bone graft–hyaluronan putty. The rabbits were killed 9 weeks later, and the lumbar spines were removed. Manual manipulation and fine detail radiography were used to assess spinal fusion, and computed tomographic images were used to quantify the volume of the fusion mass.

Results. In comparison with autograft bone alone, the fusion rates were greater when demineralized bone graft–hyaluronan putty was used as an adjunct to autogenous bone. Furthermore, the radiographic fusion rate was greater when demineralized bone graft–hyaluronan putty was used in a 2:1 ratio to autograft bone in comparison with a 1:1 ratio (P = 0.001). The addition of demineralized bone graft–hyaluronan putty to autograft bone was found to increase mineralized bone volume in a ratio-dependent manner (P < 0.05).

Conclusions. Allogeneic demineralized bone matrix–hyaluronan putty enhances rabbit posterolateral spine fusion when used as an adjunct to autogenous bone graft. This new formulation of demineralized bone matrix may facilitate greater bone formation and successful fusion.

From the *Department of Orthopaedics, Case Western Reserve University, the

†Spine Institute, University Hospitals of Cleveland, and the

‡Department of Radiology, University Hospitals of Cleveland and Case Western Reserve University, Cleveland, Ohio, USA.

Supported by a grant from the Musculoskeletal Transplant Foundation, Edison, NJ.

Acknowledgment date: October 3, 2002.

Revision date: March 6, 2003.

Acceptance date: March 13, 2003.

The device(s)/drug(s) that is/are the subject of this manuscript is/are not intended for human use.

Foundation funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence to Jung U. Yoo, MD, Department of Orthopaedics, University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106. E-mail:

© 2003 Lippincott Williams & Wilkins, Inc.