I can't cite "scholarly refs", just the response to my questions regarding the obvious.
Dialog:
Patient:
"Dr., why not remove those giant "bird beak" bone spurs from the front(s) of the cervical vertebra?"
Doctor:
"I'd advise against removing those spurs as their removal will destabilize the affected level causing a reactive cascade: including increased inflammation and increased bone spur production." "Don't mess with the spurs if it can be "avoided"".
Bone Wax:
Not sure if Mark refers to bees' wax and parafin, or Ostene as "bone wax". It would be great to get his clarification.
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Below is some research on the "bone wax" issue.
Bone wax is made of beeswax <http://en.wikipedia.org/wiki/Beeswax> containing a softening agent such as paraffin.
Bone wax is used to mechanically stop bone bleeding during surgical procedures.
The bone wax is smeared across the bleeding edge of the bone, blocking the holes and causing immediate bone hemostasis <http://en.wikipedia.org/wiki/Bone_hemostasis> through a tamponade <http://en.wikipedia.org/wiki/Tamponade> effect.
Bone wax is supplied in sterile sticks, and most often requires softening before it can be applied. Once applied, it essentially never goes away. Although inexpensive, easy to use and immediate, bone wax has a number of adverse reactions associated with it.
Bone wax inhibits formation of new bone osteogenesis <http://en.wikipedia.org/wiki/Osteogenesis> and acts a physical barrier preventing bone union.
[1] <http://en.wikipedia.org/wiki/Bone_wax#_note-one>
[2] <http://en.wikipedia.org/wiki/Bone_wax#_note-two>
In the presence of bone wax, osteoblasts <http://en.wikipedia.org/wiki/Osteoblasts> will be absent in a bone defect.
[3] <http://en.wikipedia.org/wiki/Bone_wax#_note-three> In defects where bone wax was applied and removed after 10 minutes, there was complete inhibition of bone regeneration.
[4] <http://en.wikipedia.org/wiki/Bone_wax#_note-four> For this reason bone wax is almost never used in areas where bone fusion is critical.
[5] <http://en.wikipedia.org/wiki/Bone_wax#_note-five>
Bone wax increases infection rates and impairs the ability of bone to clear bacteria.
[6] <http://en.wikipedia.org/wiki/Bone_wax#_note-six> In the presence of bone wax, the number of bacteria needed to produce osteomyelitis <http://en.wikipedia.org/wiki/Osteomyelitis> is reduced by a factor of 10,007 In a recent study of infection rates following spinal surgery, surgical site infections occurred in 6 of 42 cases in which bone wax was used, and in only 1 of 72 cases in which it was not used.
[7] <http://en.wikipedia.org/wiki/Bone_wax#_note-eight>
Infection and non-union are a particularly important problem in cardiac surgery <http://en.wikipedia.org/wiki/Cardiac_surgery> .
[8] <http://en.wikipedia.org/wiki/Bone_wax#_note-nine> According to the American Heart Association, the incidence of deep sternal wound infections <http://en.wikipedia.org/w/index.php?title=Sternal_wound_infection&action =edit> is 1% to 5% of patients undergoing coronary artery bypass surgery <http://en.wikipedia.org/wiki/Coronary_artery_bypass_surgery> , with a mortality rate of about 25%.
[9] <http://en.wikipedia.org/wiki/Bone_wax#_note-0>
Bone wax remains as a foreign body <http://en.wikipedia.org/wiki/Foreign_body> for many years, and can cause a giant cell <http://en.wikipedia.org/wiki/Giant_cell> reaction and local inflammation.[
10] <http://en.wikipedia.org/wiki/Bone_wax#_note-ten> In skull base <http://en.wikipedia.org/w/index.php?title=Skull_base&action=edit> surgery, bone wax has been reported to cause granuloma <http://en.wikipedia.org/wiki/Granuloma> formation and CSF <http://en.wikipedia.org/wiki/CSF> fluid leaks.
[11] <http://en.wikipedia.org/wiki/Bone_wax#_note-eleven>
[12] <http://en.wikipedia.org/wiki/Bone_wax#_note-twelve>
The FDA has recently approved a new water soluble bone hemostasis material designed to look and feel like bone wax.
[13] <http://en.wikipedia.org/wiki/Bone_wax#_note-1> This material is comprised of a sterile mixture of water-soluble alkylene oxide copolymers <http://en.wikipedia.org/w/index.php?title=Alkylene_oxide_copolymer&actio n=edit> , derived from ethylene oxide and propylene oxide. These copolymers have a long history in the medical and pharmaceutical fields, and they are considered inert <http://en.wikipedia.org/wiki/Inert> . These compounds are not metabolized <http://en.wikipedia.org/wiki/Metabolized> , but eliminated from the body unchanged. It is anticipated that with the introduction of these new hemostatic materials, the incidence of surgical bone infections <http://en.wikipedia.org/wiki/Infections> , non-union <http://en.wikipedia.org/w/index.php?title=Non-union&action=edit> and inflammatory <http://en.wikipedia.org/wiki/Inflammatory> complications will decrease with time.
The alternative to bone wax is called Ostene. It does not have any of the complications known to occur with the use of traditional bone wax. However its overall efficacy as a "replacement" for bees wax bone wax remains undetermined.
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Although lengthy, these citations bring into question the safety of the use of bees wax as "bone wax", and alternatively, the unclear efficacy as a replacement, of Ostene.
This may be why the US docs that I've consulted have shuddered when I've mentioned the removal of large osteopyhytes OUTSIDE the vertebral canal e.g. around the vertebral body as part of any anterior surgery esp. ADR.
Let me assure you that there is no one in Dodge who is more interested in having bone spurs removed than this reporter, but between their (osteophytes) "function(s)", supporting the failing and increasingly unstable vertebral column, and the purported dangers of their removal, one may reasonably pause to consider the consequences before blithely advancing forward into the OR and having them (please God) removed.
I hope that Mark, our unparalleled expert on all things spinal, will weigh in on this important and distubing topic. I for one have a great deal at stake in getting this issue resolved. In the meantime I will personally consult several US top docs on this issue and when I have their responses they'll be posted on these "pages" ASAP. In addition I hope that you will bring your considerable savvy, experience and the powerful access your beat confers to bear.
I hope I've gone a little way in answering your previous post.
Good luck!
