Antonacci Christopher L, Davey Annabelle P, Kia Cameron, Zhou Hanbing
Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA.
Orthopedic Associates of Hartford, Hartford Hospital Bone and Joint Institute, Hartford, CT, USA.
J Spine Surg. 2024 Dec 20;10(4):715-723. doi: 10.21037/jss-24-55. Epub 2024 Dec 17.
As the global population ages, degenerative spinal disorders are on the rise, leading to an increased focus on optimizing spinal fusion therapies. Despite the high success rate of iliac crest bone autografts, their usage is hampered by donor site morbidity and limited supply. The objective of this review is to assess the viability of ceramic-based synthetic materials as alternatives in spinal fusion surgeries.
A review of national databases was performed using key terms "allograft", "nanosynthetic", "spine", and "surgery" for literature from 1900 to 2024. Studies that aimed to describe the utility of ceramic allografts, associated outcomes, limitations, and future directions were included. Studies that were not in English were excluded.
Successful spinal fusion relies on osteoconductivity, osteoinductivity, osteogenesis, and osteointegration. Ceramic-based materials, primarily calcium sulfates, phosphates, hydroxyapatites (HAs), and silicon nitrides, are recognized for their osteoconductive properties. Recent studies suggest the efficacy of ceramics as graft extenders and highlight both their compatibility and cost-effectiveness. Innovations like nanosynthetic bone grafts have shown potential in preclinical trials, offering enhanced bone formation and resorption properties. The narrative review details comparative outcomes of various synthetic grafts against autografts and allografts, indicating similar fusion rates with potentially lower complication rates.
Ceramic-based synthetic materials represent a significant advancement in spinal fusion procedures, with properties that can potentially match those of autografts. Nanosynthetic grafts, in particular, exhibit promising results in animal studies and initial clinical trials. The continuous development and evaluation of these materials could optimize fusion rates and reduce the morbidity associated with autograft harvesting. However, further research is required to assess long-term outcomes and determine the best practices for their use in spinal surgeries.
随着全球人口老龄化，退行性脊柱疾病日益增多，这使得人们更加关注优化脊柱融合治疗方法。尽管髂嵴自体骨移植成功率很高，但其应用受到供区并发症和供应有限的限制。本综述的目的是评估陶瓷基合成材料作为脊柱融合手术替代物的可行性。
使用关键词“同种异体移植物”“纳米合成材料”“脊柱”和“手术”对1900年至2024年的国家数据库进行文献检索。纳入旨在描述陶瓷同种异体移植物的效用、相关结果、局限性和未来方向的研究。排除非英文研究。
成功的脊柱融合依赖于骨传导性、骨诱导性、骨生成和骨整合。陶瓷基材料，主要是硫酸钙、磷酸盐、羟基磷灰石（HAs）和氮化硅，因其骨传导特性而受到认可。最近的研究表明陶瓷作为移植物扩展剂的有效性，并强调了它们的兼容性和成本效益。纳米合成骨移植等创新在临床前试验中显示出潜力，具有增强的骨形成和吸收特性。叙述性综述详细介绍了各种合成移植物与自体移植物和同种异体移植物的比较结果，表明融合率相似，并发症发生率可能更低。
陶瓷基合成材料代表了脊柱融合手术的重大进展，其性能有可能与自体移植物相匹配。特别是纳米合成移植物在动物研究和初步临床试验中显示出有前景的结果。这些材料的持续开发和评估可以优化融合率，并降低与自体移植物采集相关的并发症。然而，需要进一步研究来评估长期结果，并确定其在脊柱手术中使用的最佳方法。
