DBM’s use is supported in the literature as a supplement to iliac crest autograft and use beyond these indications is quite speculative and in some instances inconsistent with clinical trials.
In one cited study of cervical fusions, DBM with freeze dried allograft versus iliac crest bone graft alone, the nonunion rate was nearly twice as high in the DBM + Allograft group (46.2%) versus ICBG (26.3%). It should become more apparent from such studies that cervical fusions are not the “slam-dunk” often believed in the world of spine.
May I add, that the amount of bone needed for multilevel cervical fusions is of such low volume, there should be little if any reason to use DBM to supplement ICBG, as with just a single pass of the Corex, one could probably have enough material for a one to two level fusion (typical volume for a single level is around 1.2 to 1.5 cc).
In summary, I don’t know why DBM is a popular material in spine fusions (except for multi-level thoraco-lumbar fusions, in which insufficient ICBG is available for harvest) or why it is used at all in cervical fusions!
“Use of demineralized bone matrix in spinal fusion,” Tilkeridis, et al, World Journal of Orthopedics, 2014 Jan. 18; 5(1): 30-37 – “The purpose of this review is to present the results of clinical studies concerning the use of demineralized bone matrix (DBM), alone or as a composite graft, in spinal fusion. A critical review of the English-language literature was conducted on Pubmed, using key words “demineralized bone matrix”, “DBM”, “spinal fusion”, and “scoliosis”. Results had been restricted to clinical studies. The majority of clinical trials demonstrate satisfactory fusion rates when DBM is employed as a graft extender or a graft enhancer. A limited number of prospective randomized controlled trials (4 studies), have been performed comparing DBM to autologous iliac crest bone graft in spine fusion……
Regarding use of DBM in cervical spine fusion, it is clear that when used as an extender with autologous bone graft in PEEK cages, shows good results, although in a level two study where Freeze-dried allograft augmented with DBM compared with ICBG, the autograft group showed superior non-union rates (Pseudarthrosis rate was 46.2% in DBM-allograft Group vs 26.3% in autograft group)….
Concluding, the majority of the clinical trials demonstrate comparable efficacy of DBM when used as a graft extender in combination with autograft, but there is no clinical evidence to support its use as a standalone graft material.”
