Question

Could you write a topic on Biomaterials in spine surgery ?

Answer 1

Biomaterials in Spine Surgery

Over the past decades, use of biomaterials in the spine surgery has been greatly increased over the autograft which might reduce the invasion procedure towards regeneration rather than fusion. There are many potent biomaterials which is shown to be potent in spine surgery and some of them will be discussed here -

1.Autologous bone graft

Autologous bones can be derived from the iliac crest and local spinous processes and possess osteogenic, osteoinductive and osteoconductive properties.These autologous graft can be either cancellous or cortical bone or both.Cancellous bone have inherent properties of neovascularization,cellular recruitment,osteoid deposition and mineralization itself and that provides higher stability of the bone.However, it has some disadvantage over higher advantage.The autologous bone grafting takes more time for surgery procedure,limited material availability and higher morbidity and pain at the site of donor site.

2.Allogenic bone graft  

Allogenic bone graft can be obtained from the human cadavers.It has mineralized bone matrix has osteoconductive properties but not the osteogenic.It doesn't cause donor site morbidity ,readily available for use and reduces the chances of infection.However it has some drawback like it takes long time for incorporation and vacularization.

3.Bone marrow aspirates(BMA)

Bone marrow aspirates is the cell based system and can be obtained from iliac crest or pedicle of the spine.It diffuses at the site of injection and uses the carrier material such as autograft,allograft and ceramics etc.It is quite challenging in application.BMA contains pluripotent mesenchymal stem cells and tend to differentiate to form osteogenic progenitor cells.

4.Demineralized bone matrix ,ceramic and growth factors  

Demineralized bone matrix can be created from the allograft and act as an extender.In this process,bone matrix is used to removed ,only collagenous and non collagenous protein provide the osteoconductive properties.Growth factor provides the osteoinductiveness in fusion environment.

Bioceramics which is calcium based bone grafts and function with the autologus bone graft and BMA.It has many advantage over above biomaterial such as it is biodegradable,non-inflammatory, non toxic and can be produced in adequte quantity.

Bone morphogenic factors acts as a soluble cytokines such as TGF-beta.It promotes the speedy bone growth and enforces the differentiation and development of the progenitor cells.It has been considered a very effective method for the spine surgery.