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Gregory J. Zipfel, Bernard H. Guiot, and Richard G. Fessler

In recent years our understanding of spinal fusion biology has improved. This includes the continued elucidation of the step-by-step cellular and molecular events involved in the prototypic bone induction cascade, as well as the identification and characterization of the various critical growth factors governing the process of bone formation and bone graft incorporation. Based on these fundamental principles, growth factor technology has been exploited in an attempt to improve rates of spinal fusion, and promising results have been realized in preclinical animal studies and initial clinical human studies. In this article the authors review the recent advances in the biology of bone fusion and provide a perspective on the future of spinal fusion, a future that will very likely include increased graft fusion rates and improved patient outcome as a result of the successful translation of fundamental bone fusion principles to the bedside.

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Victor J. Matukas, Jerald T. Clanton, Keith H. Langford, and Patricia A. Aronin

T he purpose of this paper is to describe the use of hydroxylapatite as an adjunct to bone grafting in cranial defects. Hydroxylapatite is a dense, pure ceramic material with the chemical formula Ca 10 (PO 4 (OH) 2 ). 9 Durapatite (a nonresorbable particulate form of hydroxylapatite) has been extensively evaluated as a tissue implant material in animals. Interpore is a coraline porous form of hydroxylapatite with the same chemical formula as Durapatite. It was found by Drobeck, et al. , 4 that hydroxylapatite implanted subcuta-neously in animals did not

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Tokutaro Tanaka, Toshiaki Ninchoji, Kenichi Uemura, Hiroshi Ryu, Masashi Sugiura, Haruyuki Ohishi, Mamoru Tomita, Seiya Takehara, and Takamichi Yamamoto

M ultilevel anterior cervical decompression and fusion procedures have been widely employed in the treatment of myelopathy due to a long ossified posterior longitudinal ligament and/or multilevel cervical spondylosis. 2, 7, 11, 12, 15 Reported sources for bone graft include the iliac crest, rib, tibia, and fibula. 3, 7, 10, 20 There are several problems associated with these grafts. A graft from the iliac crest cannot be shaped to the exact size desired, is not strong enough, 4, 10, 20 and is complicated by hip pain. Rib grafts are not strong, 8 and few

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Vijay Letchuman, Leonel Ampie, Winward Choy, Joseph D. DiDomenico, Hasan R. Syed, and Avery L. Buchholz

S pinal fusion remains the gold-standard surgical intervention for the management of spinal conditions caused by degeneration, deformity, infection, or trauma. 1–6 Current surgical procedures involve fixation systems complemented by bone grafts or bone graft substitutes in an effort to promote adequate fusion. 2 Pediatric spinal corrective surgery is a relatively frequent pediatric procedure, with an estimated 14,264 cases conducted in 2009. 7 A majority of pediatric spinal fusions are performed for severe cases of idiopathic scoliosis, neuromuscular

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Toyohiko Isu, Kyosuke Kamada, Nobuaki Kobayashi, and Shoji Mabuchi

A nterior interbody fusion of the cervical spine is a widely used surgical procedure for the treatment of cervical intervertebral disc disease. In general, autogenous bone from the iliac crest is used for interbody fusion. 2, 5 In order to avoid the complications associated with the iliac donor site, 7 such as pain, hematoma, or infection, we attempted anterior cervical fusion using bone grafts obtained from cervical vertebral bodies (RC Williams, personal communication, 1990). The purpose of this report is to describe our surgical technique. Clinical

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Benjamin D. Elder, Wataru Ishida, C. Rory Goodwin, Ali Bydon, Ziya L. Gokaslan, Daniel M. Sciubba, Jean-Paul Wolinsky, and Timothy F. Witham

W ith the advent of new adjunctive therapies such as stereotactic body radiation therapy, proton beam therapy, and molecular-targeted therapy, the overall survival rate of patients with spinal column tumors undergoing resection has been improving over the last two decades. 24 , 28 , 29 , 37 Also, due to novel reconstruction techniques, such as titanium mesh cages and expandable cages, and various bone graft and bone graft extender options, more complex reconstructions have become feasible for patients following spinal column tumor resection. Hence, not

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Donald H. Wilson and Dwight D. Campbell

spondylosis at several levels. The myelogram showed root cutoffs more severe on the appropriate side at C4–5 and C5–6. These discs were removed at one operation. The patient was not relieved. Later, the C6–7 disc was removed and a Smith-Robinson fusion performed at this level without noticeable effect. Bone grafts were then placed at the original discectomy sites. This patient was unrelieved and remains so. The second patient had suffered a “whiplash” injury. Like the first patient, his pain was diffuse and there were no focal signs of root involvement. Myelography revealed

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Michael G. Murphy and Mokhtar Gado

H irsch , 4 Boldrey, 1 and Susen 6 have each reported independently on anterior discectomy without bone graft for herniated cervical discs. Encouraged by their results, we have used this method since 1966. The procedure has been carried out on 26 patients who have been followed for 3 to 46 months clinically. Twenty patients have been followed radiographically for 9 to 24 months. Material and Method The clinical picture in all was that of a radiculitis (lateral cervical disc syndrome) In each, myelography demonstrated a lateral defect compatible with a

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Paul D. Sawin, Vincent C. Traynelis, and Arnold H. Menezes

-term spinal stability still relies on the integrity of the bone fusion. Consequently, the most important component of any stabilization construct may not be the instrumentation, but rather the bone graft. The ideal graft substrate serves two major functions: it facilitates osteogenesis and confers structural support. 23–25 Osteogenesis is the process by which new bone is synthesized by cells native to the graft or by those derived from surrounding host tissues. 24 Three graft-derived elements must be provided for bone regeneration to occur after graft implantation: an

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Brian Fiani, Ryan Jarrah, Jennifer Shields, and Manraj Sekhon

complemented with autologous bone grafts to induce bone growth and achieve optimal fusion success. 2 However, much of this instrumentation has led to cost and safety concerns among patients, while also prolonging and complicating the recovery process. 2 Moreover, due to the greater prevalence of aging populations reducing the possibility of using autologous bone grafts, newer and more sophisticated techniques are warranted in order to aid in spinal fusion success. 2 With improved understanding of the molecular mechanisms that drive osteoblast formation, biomaterials have