Unfortunately, the viability of cells in non-vascularized, processed allogeneic bone grafts (cellular bone matrix) is unknown. Some would suggest that this only occurs when autogenous bone has been implanted immediately or when a bone graft substitute has been enriched with autogenous cells. Where rhBMPs have been engineered to maintain the growth factors, the processing of DBMs causes significant variability in the amount of osteoinductive factors that remain in the final product.Ī bone graft is considered osteogenic if it contains living osteogenic cells that are able to survive in the host environment. Only a bone graft that is preserved with an osteoinductive factor (e.g., members of the transforming growth factor family) can be considered osteoinductive.

An osteoinductive bone graft (rhBMP, formulated DBM) is defined as a material that can induce the differentiation of mesenchymal cells into osteoblasts. Resorption time, porosity, and mechanical strength can vary widely in this class of products. Whether natural (allograft, simple demineralized bone matrix) or synthetic (hydroxyapatite, calcium phosphate), structure is key to an osteoconductive scaffold providing a suitable workplace for bone forming cells. The use of steroids and bisphosphonates.The way a bone grafting technology works depends on many factors including the properties of the graft itself.Missed 3 months of conservative treatment without success.Candidate for more than two-level intervention.Reduced distance of walking due to non-spinal related causes.Fracture i the lower back within a year prior to inclusion.Any disease demanding obligate thromboprophylaxis treatment, including mechanical valve, (DVT with cancer/thrombophilia, AMI, apoplexia cerebri, TCI, valve-operation) 75 years, EF A score of 6 and more on Konno´s 'History of Examination Characteristic'.Spinal stenosis, olisthesis grade 1-2 (>3 mm), facet joint arthrosis and flavus hypertrophia verified by a mr-scan and x-ray including maximally 2 levels ranging from L1-S1.There are no difference in the clinical parameters measured by ODI and fusion rates comparing i-FACTOR® and allograft in non-instrumented posterolateral spondylodesis-operations in patients 60 years and older. To the investigators knowledge this is the first prospective study comparing fusion rates and postoperative clinic with i-FACTOR vs allograft in older patients operated with decompression and spondylodesis because of spinal stenosis due to degenerative spondylolisthesis. 171-79) why the investigators find this material suited for fusion surgery in the elderly. P-15, bound to Anorganisk Bone Mineral (ABM), called i-FACTOR®, shows fusion superiority, no side effects and no risk of transferring disease(Thorwarth et al. Studies attending these issues find a correlation between fusion and clinical outcome, why obtained fusion of the affected levels are very important(Andersen et al. In addition fusion is desired achieving stability avoiding a new compression of the nerves. Nevertheless, a decompression and, if needed, a spinal fusion is recommended.(Ausman).Ĭlinical improvement including decrease of pain, improved ADL-function and an increased quality of life are parameters of highest interest and the purpose of an operation is clear: Making sufficient room for the affected nerves. Hee HT and Wong McGregor AH FAU - Hughes and Hughes Xu et al.), but the most optimal treatment is still debated. Operative intervention shows very good results according to physical ability and pain(Christensen FB et al. LSS occurs in a combination of degenerative changes in the lower back, including hypertrophy of the ligamentum flavus, arthrosis of the facet joints and bulging of the disc.Ĭurrent treatment of LSS is varied ranging from non-operative conservative treatment to operation. LSS causes constriction of the nerves in the lumbar spine resulting in pain in the legs and lower back, especially when standing and walking, known as neurogenic claudication(Goh KJ FAU - Khalifa et al.). The average life expectancy in Denmark is increasing resulting in an increasing part of the population having age-related disease, ex lumbar spinal stenosis (LSS). Why Should I Register and Submit Results?.

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