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 or 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 Bone substitutes and • • expanders in Spine Surgery: A Factors review of their fusion • PDGF, TGF- B efficacies Int J Spine Surg. 2016; 10: 33 . Platelet Gel • Abhijeet Kadam, MD,corresponding author1 Paul W Millhouse, MD,2 Christopher K Kepler, MD, MBA,2 Platelet Rich Plasma Kris E. Radcliff, MD,2 Michael G. Fehlings, MD, PhD, • FRCSC,3 Michael E. Janssen, DO,4 Rick C. Sasso, Literature is mixed MD,5 James J. Benedict, PhD, MD,6 and Alexander R Vaccaro, MD, PhD, MBA2 • Bone Graft and Bone Graft Not recommended nor • • Substitutes in Spine Surgery: supported at this time Current Concepts and in spine surgery 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
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