Cost and Efficacy: an Update Stephen Curtin M.D. Bone marrow - - PowerPoint PPT Presentation

Cost and Efficacy: an Update Stephen Curtin M.D.

• Bone marrow
• Simple aspirate added to various “synthetic bone”
• Platelets
• Platelet Gel
• Platelet Rich Plasma
• Mesenchymal Stem Cells
• Osteoprogenitor Cells

• Cost is in the Needle
• Simple can be

aspirated from crest

• r pedicle
• Typically added to

allomatrix and DBM as an Extender

• Ineffective as a Stand

alone in combination with collagen- hydroxyapatite sponge

• NovaBone : Calcium Phosphosilicate
• Vitoss: “Porous” Calcium Phosphate and

Bioactive glass

• ProOsteon: HA CaCO2 &CaPO4
• Norian: CaPO4
• MasterGraft: HA & B-TCP

• Autologous Growth

Factors

• PDGF, TGF-B
• Platelet Gel
• Platelet Rich Plasma
• Literature is mixed
• Not recommended nor

supported at this time in spine surgery

• Bone substitutes and

expanders in Spine Surgery: A review of their fusion efficacies Int J Spine Surg. 2016; 10: 33.

Abhijeet Kadam, MD,corresponding author1 Paul W Millhouse, MD,2 Christopher K Kepler, MD, MBA,2 Kris E. Radcliff, MD,2 Michael G. Fehlings, MD, PhD, FRCSC,3 Michael E. Janssen, DO,4 Rick C. Sasso, MD,5 James J. Benedict, PhD, MD,6 and Alexander R Vaccaro, MD, PhD, MBA2

• Bone Graft and Bone Graft

Substitutes in Spine Surgery: Current Concepts and Controversies

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: January 2013 - Volume 21 - Issue 1 – p51- 60 Grabowski, Gregory MD; Cornett, Chris A. MD

• Requires

Preparation/Centrifuge

• Generally not covered

by insurance

• No controlled clinical

trials

• $5000 Back Pain

treatment

• Currently commercial

products are allograft

• Limited Data
• More Evidence is

Needed

• Autogenous Banking

in the Future?

• Marrow Aspirate: theoretical advantage as an

adjunct, not stand alone, low cost

• Platelets and PRP: No data or contradictory

data, high cost

• Mesenchymal Progenitor Cells: Auto sources

are futuristic, costly, current Allo souces lack data