Grindel JM, Jaworski T, Emanuele RM, et al. Pharmacokinetics of a
novel surface-active agent, purified Poloxamer 188, in rat, rabbit, dog
and man. Biopharm Drug Dispos 2002;23:87-103.
 Jewell RC, Khor SP, Kisor DF, et al. Pharmacokinetics of RheothRx
injection in healthy male volunteers. J Pharm Sci 1997;86:808-12.
 Lee TC, Ho JT, Hung KS, et al. Bone morphogenetic protein gene
therapy using a fibrin scaffold for a rabbit spinal-fusion experiment.
 Liu KD, Chertow GM. Acute renal failure. In: Fauci AS, Braunwald E,
Kasper DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J, editors.
Harrison's principles of internal medicine. 17
ed. New York:
MacGraw-Hill Co.; 2008. p. 1752-61.
 Pepys MB, Hirschfield GM. C-reactive protein: a critical update. J Clin
 Sudmann B, Bang G, Sudmann E. Histology verified bone wax
(beeswax) after median sternotomy in 17 of 18 autopsy cases.
 Wang MY, Armstrong JK, Fisher TC, et al. A new, Pluronic-based,
bone hemostatic agent that does not impair osteogenesis. Neurosurgery
 Wellisz T, An YH, Wen X, et al. Infection rates and healing using bone
wax and a soluble polymer material. Clin Orthop Relat Res 2008;466:
 Wellisz T, Armstrong JK, Cambridge J, et al. Ostene, a new water-
soluble bone hemostasis agent. J Craniofac Surg 2006;17:420-5.
 Wetteland P, Røger M, Solberg HE, et al. Population-based erythrocyte
sedimentation rates in 3910 subjectively healthy Norwegian adults. A
statistical study based on men and women from the Oslo area. J Intern
 Willcox ML, Newman MM, Paton BC. A study of labeled Pluronic F-68
after intravenous injection into the dog. J Surg Res 1978;25:349-56.
I congratulate the authors on a well-done study involving
Ostene. Ostene (water-soluble alkylene oxide copolymers),
a synthetic bone hemostatic agent, was evaluated in a rabbit
model (18 rabbits) where it was applied to a bone defect in
the iliac crest. The animals were placed into 3 groups: (1)
bone wax, (2) treated with Ostene, (3) no treatment.
Laboratory studies sequentially evaluated WBC, CRP, and
ESR obtained at 0, 1, 3, and 6 weeks after the procedures;
animals were killed at 6 postoperative weeks. A group 4
was also created (6 rabbits) and was evaluated following the
application of Ostene alone, and BUN and creatinine studies
were obtained to rule out systemic nephrotoxicity. Labora-
tory studies (WBC, CRP, and ESR) in the animals in groups
1 to 3 remained normal postoperatively. The amount of
postoperative blood loss at the surgical sites in group 2
rabbits was slightly but not significantly greater than for
group 1 rabbits, whereas those in group 3, where no
hemostatic agent was used, sustained a greater local blood
loss. Histologic evaluations revealed that group 1 subjects
exhibited fibrosis at the site where bone wax was used,
group 2 animals demonstrated no Ostene residua, and
groups 2 and 3 demonstrated no fibrotic tissue at the bone
defect sites. Furthermore, there were no systemic changes in
BUN and CRP in group 4 animals. The authors concluded
that Ostene reabsorbs and is not associated with any
systemic toxicity or inflammatory local tissue reaction as
tested in a rabbit animal model. In summary, Ostene would
appear to be an extremely useful alternative to bees wax,
because the latter is responsible for a significant inflamma-
tory response (remains in situ for more than a 10-year
period and becomes encapsulated with fibrotic tissue), and
inhibits new bone formation. This is an excellent study, is
clear, and is well thought of. Furthermore, it should prompt
spinal surgeons to choose Ostene instead of bone (bees) wax
in the future.
Nancy Epstein, MD
Long Island Neurosurgical Associates
New Hyde Park, NY 11042-1101, USA
S2:79T.-C. Lee et al. / Surgical Neurology 72 (2009) S2:75–S2:79