PubMed · 6993307
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C Tauber, A Israeli, H Horoszowski, I Farine. 1980-01-15. [Massive bone allografts].. https://pubmed.ncbi.nlm.nih.gov/6993307/
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The most readily available source for autologous bone graft used in spinal fusion (the gold standard) is the iliac crest. However, the open surgical approach for harvesting corticocancellous iliac bone is associated with a marked increase in morbidity. This study suggests two alternatives to the traditional open harvesting procedure. For anterior interbody fusion procedures using a cage, the autologous bone is harvested regionally from a neighboring vertebral body. Alternatively, using minimally invasive techniques, a custom bone graft harvester with a flexible tube and cutting tip allows harvesting of autologous bone from a single entry point at the iliac crest. The effect on the mechanical strength of a lumbar vertebra of removing a cylindrical regional bone graft was studied in a cadaveric model. The bone defect was filled using three different filler materials: a porous tri-calcium phosphate plug, a porous tantalum plug, and a self-setting calcium phosphate cement. After plug removal, the vertebral body's strength in flexion/compression loading was reduced significantly, but could be restored to at least intact values with any of the three filler materials. The minimally invasive bone graft harvester was tested in three cadaveric pelves. With the cutting tip being guided within the cortical boundaries of the pelvis, cancellous bone volumes of 10-20 cc could be harvested from each iliac bone. Regional bone graft harvest in anterior spine surgery is suggested to be anatomically safe and biomechanically acceptable. Any of the three filler materials can restore the vertebral body's mechanical strength, but the filler's long-term resorption/remodeling or osteointegration behavior is unknown. The minimally invasive bone graft harvester is a novel tool, which performed satisfactorily under laboratory conditions, but clinical results are still missing.
The uncertainties about the transmission of prion proteins from xenogenic grafts prepared from bovine bone has led to the reconsideration of allogenic bone as a grafting material. Allografting is a complementary technique to autografting nowadays when large bone volumes are necessary. Several preparation techniques have been proposed. Fresh-frozen, freeze-dried and gamma irradiation are the most common. However, a large amount of lipids is present in the medullary spaces (near 70% in weight for a human femoral head). They are known to strongly influence the biocompatibility of the bone graft. The exact changes of lipids upon the sterilization and storage processes are poorly known. The aims of the present study were to appreciate the effects of gamma irradiation on medullary lipids and to identify the cytotoxicity of gamma-irradiated bank bone with/without lipid on cultures of osteoblast-like cells. Bone cores from 8 femoral heads retrieved during prosthesis surgery for arthritis were prepared with a drilling trephine. Cores were either sterilized by gamma radiations (25000 gray) or kept frozen until lipid extraction and lipofuschine-like dosage by Folch's method and fluorometric study. Peroxidated lipids appeared 2 to 3-fold higher in the gamma-irradiated cores than in frozen ones. Slices were prepared from bone cores and were transferred on confluent osteoblast-like cell layers (Saos-2). The raw slices (containing lipids) did not induce cell death. On the other hand, cell death was dramatically increased around the gamma-irradiated slices. Defatted slices which had been sterilized by gamma radiations or UV did not induce cell death. Defatting procedures should be added when preparing bone allografts in human bone banks.