OBJECTIVE: The aim of the present review is to critically discuss various surgical implications and level of evidence of most commonly employed bone graft substitutes for spinal fusion.
METHOD: Data was collected via electronic search using "PubMed", "SciFinder", "ScienceDirect", "Google Scholar", "Web of Science" and a library search for articles published in peer-reviewed journals, conferences, and e-books.
RESULTS: Despite having exceptional inherent osteogenic, osteoinductive, and osteoconductive features, clinical acceptability of autografts (patient's own bone) is limited due to several perioperative and postoperative complications i.e., donor-site morbidities and limited graft supply. Alternatively, allografts (bone harvested from cadaver) have shown great promise in achieving acceptable bone fusion rate while alleviating the donor-site morbidities associated with implantation of autografts. As an adjuvant to allograft, demineralized bone matrix (DBM) has shown remarkable efficacy of bone fusion, when employed as graft extender or graft enhancer. Recent advances in recombinant technologies have made it possible to implant growth and differentiation factors (bone morphogenetic proteins) for spinal fusion.
CONCLUSION: Selection of a particular bone grafting biotherapy can be rationalized based on the level of spine fusion, clinical experience and preference of orthopaedic surgeon, and prevalence of donor-site morbidities.
RESULTS: Biochar+compost application resulted in 37% and 300% higher soil total organic carbon and available phosphorus content, respectively, during the first 3 years of experimentation compared to control. Similarly, trunk diameter and shoot number of apple trees increased 23-26% by the end of the first year. Nevertheless, there were no significant changes in fruitfulness, fruit weight or starch pattern index as productivity indices.
CONCLUSION: Biochar and compost were beneficial in improving soil quality, mainly by increasing soil nutrient content and decreasing soil bulk density, and in increasing plant growth at early growth stages of apple orchards. However, they failed to enhance overall yield and fruit quality, most likely due to their limited ability to suppress apple replant disease. © 2018 Society of Chemical Industry.