A systematic review of bone graft products used in lumbar interbody fusion procedures for degenerative disc disease

Background: Degenerative disc disease (DDD) is associated with chronic lower back pain that may have impacts on individual's quality of life and functional ability. Lumbar interbody fusion can be carried out with a variety of bone grafting products, the choice depends on several factors includi...

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Main Authors: Anita Fitzgerald, MPH, Rachael McCool, BSc, Emma Carr, BA, Paul Miller, MSc, Katie Reddish, BSc, Cynthia C Lohr, DC, Elena Annoni, MSc, Brandon Lawrence, MD
Format: Article
Language:English
Published: Elsevier 2025-03-01
Series:North American Spine Society Journal
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Online Access:http://www.sciencedirect.com/science/article/pii/S2666548424002725
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author Anita Fitzgerald, MPH
Rachael McCool, BSc
Emma Carr, BA
Paul Miller, MSc
Katie Reddish, BSc
Cynthia C Lohr, DC
Elena Annoni, MSc
Brandon Lawrence, MD
author_facet Anita Fitzgerald, MPH
Rachael McCool, BSc
Emma Carr, BA
Paul Miller, MSc
Katie Reddish, BSc
Cynthia C Lohr, DC
Elena Annoni, MSc
Brandon Lawrence, MD
author_sort Anita Fitzgerald, MPH
collection DOAJ
description Background: Degenerative disc disease (DDD) is associated with chronic lower back pain that may have impacts on individual's quality of life and functional ability. Lumbar interbody fusion can be carried out with a variety of bone grafting products, the choice depends on several factors including the patient, site, procedure, cost and indication. This systematic review (SR) intends to validate and consolidate the existing evidence base supporting bone graft materials related to lumbar interbody fusion procedures for DDD, specifically anterior lumbar interbody fusion (ALIF) and oblique lumbar interbody fusion (OLIF). Methods: An SR was conducted in February 2023. Clinical and economic studies of adults with DDD in regions L2 to S1 undergoing lumbar interbody fusion with Infuse™, allograft, synthetic bone grafts, demineralized bone matrices or cell-based matrices were eligible for inclusion. Results: Twenty-one studies (reported in 25 publications) were included in the review. Eighteen studies (reported in 22 publications) reported clinical outcomes, while 4 studies reported economic outcomes. Nine studies (in 5 publications) investigated Infuse™, including 3 randomized controlled trials (RCTs), one cohort study and 4 case series. Ten studies investigated allograft bone, bone harvested from the vertebral spur combined with apacerum powder, or tricalcium phosphate soaked in autologous bone marrow aspirate, including one RCT, 2 cohort studies, and 7 case series. Conclusions: The SR shows that Infuse™ offers comparable results to iliac crest bone graft with the benefit of not requiring harvested bone and offers significant benefits in surgical time and blood loss. There is a lack of comparative evidence for any other bone grafts identified in this SR, highlighting the need for further well-designed studies to be conducted in this area.
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spelling doaj-art-d16f863216fe4e9cb581b52440c98afd2025-08-20T03:44:11ZengElsevierNorth American Spine Society Journal2666-54842025-03-012110057910.1016/j.xnsj.2024.100579A systematic review of bone graft products used in lumbar interbody fusion procedures for degenerative disc diseaseAnita Fitzgerald, MPH0Rachael McCool, BSc1Emma Carr, BA2Paul Miller, MSc3Katie Reddish, BSc4Cynthia C Lohr, DC5Elena Annoni, MSc6Brandon Lawrence, MD7York Health Economics Consortium, Enterprise House, University of York, York, United Kingdom; Corresponding author: York Health Economics Consortium, Enterprise House, Innovation Way, Heslington, York, YO10 5NQ, United Kingdom.York Health Economics Consortium, Enterprise House, University of York, York, United KingdomYork Health Economics Consortium, Enterprise House, University of York, York, United KingdomYork Health Economics Consortium, Enterprise House, University of York, York, United KingdomYork Health Economics Consortium, Enterprise House, University of York, York, United KingdomMedtronic, Office of Medical Affairs, Memphis, TN, United StatesHealth Economics, Policy & Reimbursement, Medtronic International Trading Sàrl, 1131 Tolochenaz, SwitzerlandDepartment of Orthopaedics, University of Utah, UT, United StatesBackground: Degenerative disc disease (DDD) is associated with chronic lower back pain that may have impacts on individual's quality of life and functional ability. Lumbar interbody fusion can be carried out with a variety of bone grafting products, the choice depends on several factors including the patient, site, procedure, cost and indication. This systematic review (SR) intends to validate and consolidate the existing evidence base supporting bone graft materials related to lumbar interbody fusion procedures for DDD, specifically anterior lumbar interbody fusion (ALIF) and oblique lumbar interbody fusion (OLIF). Methods: An SR was conducted in February 2023. Clinical and economic studies of adults with DDD in regions L2 to S1 undergoing lumbar interbody fusion with Infuse™, allograft, synthetic bone grafts, demineralized bone matrices or cell-based matrices were eligible for inclusion. Results: Twenty-one studies (reported in 25 publications) were included in the review. Eighteen studies (reported in 22 publications) reported clinical outcomes, while 4 studies reported economic outcomes. Nine studies (in 5 publications) investigated Infuse™, including 3 randomized controlled trials (RCTs), one cohort study and 4 case series. Ten studies investigated allograft bone, bone harvested from the vertebral spur combined with apacerum powder, or tricalcium phosphate soaked in autologous bone marrow aspirate, including one RCT, 2 cohort studies, and 7 case series. Conclusions: The SR shows that Infuse™ offers comparable results to iliac crest bone graft with the benefit of not requiring harvested bone and offers significant benefits in surgical time and blood loss. There is a lack of comparative evidence for any other bone grafts identified in this SR, highlighting the need for further well-designed studies to be conducted in this area.http://www.sciencedirect.com/science/article/pii/S2666548424002725Bone graftDegenerative disc diseaseIliac crest bone graftInfuse™Lumbar interbody fusionSpinal fusion
spellingShingle Anita Fitzgerald, MPH
Rachael McCool, BSc
Emma Carr, BA
Paul Miller, MSc
Katie Reddish, BSc
Cynthia C Lohr, DC
Elena Annoni, MSc
Brandon Lawrence, MD
A systematic review of bone graft products used in lumbar interbody fusion procedures for degenerative disc disease
North American Spine Society Journal
Bone graft
Degenerative disc disease
Iliac crest bone graft
Infuse™
Lumbar interbody fusion
Spinal fusion
title A systematic review of bone graft products used in lumbar interbody fusion procedures for degenerative disc disease
title_full A systematic review of bone graft products used in lumbar interbody fusion procedures for degenerative disc disease
title_fullStr A systematic review of bone graft products used in lumbar interbody fusion procedures for degenerative disc disease
title_full_unstemmed A systematic review of bone graft products used in lumbar interbody fusion procedures for degenerative disc disease
title_short A systematic review of bone graft products used in lumbar interbody fusion procedures for degenerative disc disease
title_sort systematic review of bone graft products used in lumbar interbody fusion procedures for degenerative disc disease
topic Bone graft
Degenerative disc disease
Iliac crest bone graft
Infuse™
Lumbar interbody fusion
Spinal fusion
url http://www.sciencedirect.com/science/article/pii/S2666548424002725
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