Table 4.

Summary of clinical literatures on demineralized bone matrices for spinal fusion

Ref.	Description of study
Cervical spine
An et al. [4]	A prospective comparison of an allograft-demineralized bone matrix composite versus autograft in anterior cervical spinal fusion
Lumbar spine
Thalgott et al. [85]	A case series study for anterior lumbar interbody fusion with DBM composites consisting of titanium mesh cages, coralline hydroxyapatite
Girardi et al. [37]	Retrospective review of allograft demineralized bone matrix as bone extenders for posterolateral lumbar spine fusion
Sassard et al. [76]	Retrospective review of Grafton demineralized bone matrix as bone extenders for posterolateral lumbar spine fusion
Cammisa et al. [21]	A multicenter prospective study that compared the effectiveness of a Grafton DBM gel composite with an iliac crest autograft in posterolateral spinal fusion
Vaccaro et al. [96]	A prospective comparison of bone grafting with Grafton DBM putty enriched with aspirated bone marrow, DBM putty combined with iliac crest autograft, or autograft
Scoliosis
Price et al. [73]	A retrospective study of determining the efficacy of a DBM composite consisting of DBM and bone marrow for posterior spinal fusion in scoliosis cases

Ref.	Evidence level	Conclusion
Cervical spine
An et al. [4]	I	The allograft-demineralized bone matrix construct gives a higher rate of graft collapse and pseudarthrosis
Lumbar spine
Thalgott et al. [85]	IV	The DBM composite was effective for anterior interbody fusion of the lumbar spine when used as part of a rigidly instrumented circumferential fusion
Girardi et al. [37]	II	The use of these bone graft extenders may decrease the required amount of autologous bone graft
Sassard et al. [76]	III	The percentage of patients fused was similar in both groups
Cammisa et al. [21]	II	Grafton DBM could only extend an autograft that was smaller than is normally required to achieve a solid spinal fusion
Vaccaro et al. [96]	II	The DBM composite consisting of DBM putty and aspirated bone marrow offer a similar performance as the autograft in posterolateral spinal fusion
Scoliosis
Price et al. [73]	III	The fusion rates were comparable to those of iliac bone autografts and DBM composites