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Falko Schwarz, Pedro Dünisch, Jan Walter, Yasser Sakr, Rolf Kalff and Christian Ewald

standard for skull remodeling after craniectomy, 6 , 14 but in recent years, a large number of short- and long-term complications after autologous bone flap reinsertion have been reported, including infection, bleeding, and aseptic bone resorption, which led to critical review of this technique. 2 , 4 , 5 , 9 , 18 , 23 , 24 At the same time, the use of bone substitutes for cranioplasty has attracted interest. Although the cosmetic results of “hand-made” bone cement implants have been unsatisfactory, especially for large defects, new computer-assisted design implants

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Rajender Agarwal, Kendal Williams, Craig A. Umscheid and William C. Welch

– 20 , 2006 28 Johnsson R , Stromqvist B , Aspenberg P : Randomized radiostereometric study comparing osteogenic protein-1 (BMP-7) and autograft bone in human noninstrumented posterolateral lumbar fusion: 2002 Volvo award in clinical studies . Spine 27 : 2654 – 2661 , 2002 29 Kanayama M , Hashimoto T , Shigenobu K , Yamane S , Bauer TW , Togawa D : A prospective randomized study of posterolateral lumbar fusion using osteogenic protein-1 (OP-1) versus local autograft with ceramic bone substitute: Emphasis of surgical exploration and

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Daniel K. Resnick, Tanvir F. Choudhri, Andrew T. Dailey, Michael W. Groff, Larry Khoo, Paul G. Matz, Praveen Mummaneni, William C. Watters III, Jeffrey Wang, Beverly C. Walters and Mark N. Hadley

substitute” as a key word and then again as the search focus. The search was repeated using search terms “bone substitutes,” “tricalcium phosphate,” “calcium phosphate,” “bone morphogenetic protein,” and “hydroxyapatite” combined with “spine” and “lumbar.” The search was limited to the English language and to reports on humans. The results of the searches were combined, and a total of 54 articles were identified and reviewed. The reference lists of each of these papers was reviewed, and further references were identified and subsequently submitted for review. The vast

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Anthony M. T. Chau, Lileane L. Xu, Rhys van der Rijt, Johnny H. Y. Wong, Cristian Gragnaniello, Ralph E. Stanford and Ralph J. Mobbs

1 MeSH descriptor reconstructive surgical procedures explode exp reconstructive surgical procedures exp plastic surgery 2 MeSH descriptor bone transplantation explode all trees exp bone transplantation exp bone transplantation 3 MeSH descriptor bone substitutes explode all trees exp bone substitutes exp bone prosthesis 4 MeSH descriptor prostheses and implants explode prostheses and prostheses and 5  1 or #2 or #3 or #4 or/1–4 or/1–4 6 MeSH descriptor ilium explode exp ilium exp iliac

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Michael G. Kaiser, Michael W. Groff, William C. Watters III, Zoher Ghogawala, Praveen V. Mummaneni, Andrew T. Dailey, Tanvir F. Choudhri, Jason C. Eck, Alok Sharan, Jeffrey C. Wang, Sanjay S. Dhall and Daniel K. Resnick

”[MeSH] OR “Lumbar Vertebrae”[MeSH]) AND “Spinal Fusion”[MeSH]) OR “lumbar fusion”[All Fields] OR (“lumbar”[title] AND “fusion”[title])) AND (((“Bone Substitutes”[MeSH] OR “Calcium Phosphates”[MeSH]) OR “Hydroxyapatites” [MeSH]) OR “Bone Morphogenetic Proteins”[MeSH]) AND ((“2003”[PDAT]: “3000”[PDAT]) AND “humans” [MeSH Terms] AND English[lang]). The search was limited to the English language and human subjects and yielded a total of 151 papers. The titles and abstracts of these articles were reviewed and those specifically investigating the fusion potential, clinical

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Neurosurgical Forum: Letters to the Editor To The Editor Thomas B. Ducker , M.D. Annapolis, Maryland 114 114 Abstract: Object. The purposes of bone substitutes for anterior cervical fusion (ACF) are immediate biomechanical support and osteointegration of the graft. The authors report their preliminary results in performing ACF in which carbon fiber cages (CFCs) containing coralline hydroxyapatite (HA) are used as bone substitute. Methods. During a 24-month period, anterior microsurgical discectomy was

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Umberto Agrillo, Luciano Mastronardi and Fabrizio Puzzilli

C ervical radiculopathy secondary to a disc herniation gradually improves or disappears within 2 months after symptom onset when conservative measures are applied in approximately 40% of cases. 13, 16 Anterior cervical discectomy is performed to relieve neural compression exerted by herniated discs that are unresponsive to noninvasive treatment. Often a supplemental ACF is performed following decompression, even though the incremental fusion-related benefit is not widely accepted. 6, 17, 19 The aim of using a bone substitute in ACF is to provide immediate

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Luigi Maria Cavallo, Andrea Messina, Felice Esposito, Oreste de Divitiis, Mateus Dal Fabbro, Enrico de Divitiis and Paolo Cappabianca

II, 21 patients underwent extended endoscopic transsphenoidal transtuberculum transplanum approaches to suprasellar lesions. The lesions included two suprasellar, six intra-/extraventricular, and one purely intraventricular craniopharyngioma; five pituitary adenomas; three tuberculum sellae meningiomas; three entirely suprasellar Rathke cleft cysts; and one optic nerve glioma. For reconstruction of the skull base defect we used the following materials. As a bone substitute we used a copolymer of l -lactic acid and glycolic acid (LactoSorb, Walter Lorenz Surgical

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James S. Harrop and Gregory J. Przybylski

Odontoid fractures can be successfully treated with anterior screw fixation. Odontoid fractures commonly occur in older patients who may have significant osteopenia. The authors examined the use of a bone substitute to overcome limitations encountered during a procedure in which anterior odontoid screw fixation is performed.

Two elderly patients with displaced, reducible acute odontoid fractures underwent anterior odontoid screw fixation. The intraoperative failure of the anterior vertebral cortex from osteopenic bone and failure to achieve complete contact between the dens and axis were encountered. The defects were supplemented by using the osteoconductive agent Norian. Outcome was evaluated to determine the utility of this method.

Occasional intraoperative failure of anterior odontoid screw fixation may be encountered. Supplementation of bone defects with this osteoconductive agent may facilitate successful bone union in selected patients.

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Alfredo Pompili, Fabrizio Caroli, Livio Carpanese, Mauro Caterino, Laura Raus, Giancarlo Sestili and Emanuele Occhipinti

Object. Cranioplasty is required to protect underlying brain, correct major aesthetic deformities, or both. The ideal material for this purpose is autogenous bone. When this is not available, alloplastic or artificial materials may be used. These materials should be malleable, strong, lightweight, inert, noncarcinogenic, nonferromagnetic, and, if possible, inexpensive. The authors reviewed their surgical experience with a new bone substitute and discuss outcomes in patients in whom it was used.

Methods. The 11 patients presented in this series had bone defects resulting from bone-involving tumor (eight cases), trauma (two cases), or aesthetic deformity due to repeated craniotomies (one case). The defects were repaired using Osprogel, a bone substitute that consists of calcium hydroxyapatite combined with synthetic, human bone—derived gelatin, glycerol, and water. Osprogel is not only a bioinert material but also an osteoconductive and osteoinducing substrate; when it is placed in contact with healthy cancellous bone, it induces osteogenesis and angiogenesis, thus permitting the regrowth of nearly normal bone. The sheet of Osprogel was modeled onto the cranial defect intraoperatively and was kept in place either by using a titanium micronet secured to surrounding bone with microscrews (first two cases) or by using a single- or double-layer titanium mesh secured with stitches. No complications due to the procedure were observed.

The results, evaluated at least 6 months after surgery by using three-dimensional (3-D) reconstructed computerized tomography scans, were excellent in seven patients, good in three, and fair in one. In the patient with a fair result, the repair was unsatisfactory because there was lack of experience in using the material. In part of the area to be repaired, the Osprogel was used as filler; here it was washed out and resorbed. The cases deemed as having a good result had good bone replacement; however, the curvature was faulty.

Conclusions. In the near future, this technique may be refined to achieve good or excellent results either without the use of supporting material or with the use of individual, computer-designed 3-D prostheses.