Anybody had 'bone substitute fusion'?

[dillie]

In 1995 I had an Anterior Lumbar Interbody Fusion at L4 - S1. The surgeon told me he would be using a new 'glass fibre type' bone substitute fusion material.
I've now been told that this stuff didn't heal and I have a pseudoarthrosis with a migrated staple.
The material used was hydroxyapatite-wollastonite glass ceramic blocks.
I've done a lot of searching on the web but cannot find any info on other patients having undergone this although I'm sure there must have been.
Any help gratefully received!

[Justin]

Hi dillie,

Here's an article that explains the various bone graft substitutes for spinal fusion surgery: eMedicine Orthopedic Surgery, Bone Graft Substitute Materials.

Bioactive glass (bioglass) is a biologically active silicate-based glass. Its high modulus and brittle nature make its applications limited, but it has been used in combination with polymethylmethacrylate to form bioactive bone cement and with metal implants as a coating to form a calcium-deficient carbonated calcium phosphate layer. This layer facilitates the chemical bonding of the implant to surrounding bone. Products include Biogran (developed by Orthovita and licensed to 3i, Implant Innovations, Inc, Palm Beach Gardens, Fla) and PerioGlas (NovaBone Products, LLC, Alachua, Fla).

I hope this helps.

[Justin]

Here's another great read:

Silicates and Bone Fusion
By Walid Waked, MD; Jonathan Grauer, MD
ORTHOPEDICS 2008; 31:591
June 2008

Abstract

Autologous bone grafting remains the gold standard for bone grafting in clinical practice. Although it has withstood the test of time, it remains associated with multiple comorbidities. The search for an alternative bone graft substitute harnessing bone’s osteoconductive, osteoinductive, and osteogenic properties remains a challenge. This article examines the various bone grafting materials currently in use and highlights the current properties and uses of silicon-substituted calcium phosphates as a competitive substitute for high cost materials used today.

The entire publication is found here: Silicates and Bone Fusion.

[dillie]

Thanks a lot Justin, I'll get stuck in to those! You're a great help.

What would be an even bigger help to me is to hear from other patients who've had this or to read articles about clinical outcomes that quote figures etc.
Am a bit puzzled that I haven't yet come across anything and I have done an awful lot of research!!!!!

[dillie]

Eureka!
Having had a scan through the aforementioned articles Justin I Googled again with different tags and have found quite a few papers.
Mostly they're Japanese surgeons and the compound is referred to as AWGC (Apatite and Wollastonite containing Glass Ceramic).
It appears that fusion has been achieved in several groups of patients with differing ratios of bone/compound mixtures.

Don't know why mine failed completely but it's not due to smoking, having never smoked in my life.
Just unlucky I suppose but strange that it's taken 14 years for the non-fusion to be discovered.
My new surgeon Khai Lam intends leaving these glass blocks in situ when I have the lumbar revision later in the year after I've had the cervical surgery.
Interesting!?

[dillie]

If anybody's at all interested... this is the paper :

Mixture ratios of Local Bone to Artificial Bone in Lumbar Posterolateral Fusion

Kasai; Yuichi: Takegami; Kenji; Uchida; Atsumasa;
Journal of Spinal Disorders & Techniques Feb 2003 Vol 16 Issue 1 pp31-37

[Mastermind75]

It's insane what these doctors can do!! To think that they used to use cadaver bones and parts of your own hips...now it's just cells.

[dillie]

Hi Mastermind 75
The stuff put into my spine (L4 - S1 ) in 1995 as a fusion was some type of fibreglass being used in Japan.
Trouble was it never healed and didn't contain human bone. My spine has been wobbling about ever since and I've only just been told.
Very shortly I'm having major reconstruction of L2 - S1 with a new surgeon who's using BMP ( bone morphogenic protein) a new alternative which is genetically produced from human cells so hopefully this time I'll get what I should have got 14 years ago. Plus a rod and screws of course.
I still haven't found any papers on the internet about UK patients having had this Japanese AWG fibreglass stuff so I'm wondering if I was being experimented on.
That was my main reason for posting actually, and I'd still like to hear from anybody who knows about this stuff or has had it put in their spine and what was the success rate?
PS Was due for cervical surgery first but due to worsening lumbar spine plans have changed!

[Mastermind75]

Thats what Im getting done there going to do an aspiration. There going to stick the needle into my hip remving these bone cells. There using a "cage" which almost looks like a hollowed out hockey puck.....many different variations on it. Then the cells are going to be in the middle of this cage. Patch me up and flip me over then do the rods and screws from the other side.

Your having some major work done. I wish you the best and a speedy recovery. When are you getting it done?

[dillie]

Sounds like you're having an autograft ? Your own bone tissue for the graft as opposed to an allograft - tissue from a 'donor'?
The graft I'm having isn't being harvested from me, it's been produced by gene therapy (recombinant) so hopefully I'll be spared any extra procedures.
I've been told the operation should be within the next six weeks all being well.
I hope all goes well for you too, will be watching to see how you get on. Thanks for posting,