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Li J, Zhao B, Wang W, Xu Y, Wu H, Zhang W. Improved intervertebral fusion in LLIF rabbit model with a novel titanium cage. Spine J 2024; 24:1109-1120. [PMID: 38211901 DOI: 10.1016/j.spinee.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/20/2023] [Accepted: 12/27/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND CONTEXT There is no established small animal approach model for the strict simulation of lateral lumbar interbody fusion (LLIF) surgery. PURPOSE This study aims to establish a reliable LLIF rabbit model that strictly simulates the procedure and to preliminarily evaluate the differences in fusion outcomes with different graft materials. STUDY DESIGN A controlled laboratory. METHODS Fifty-four 4-month-old white New Zealand female and male rabbits were selected and divided into five groups: Group A (dissection group) consisted of 9 rabbits, Group B (normal approach group) consisted of 9 rabbits, Group C (autogenous iliac bone group) consisted of 12 rabbits, Group D (BMP-2 carrier material group) consisted of 12 rabbits, and Group E (allograft bone group) consisted of 12 rabbits. Based on data from Group A, a novel titanium metal fusion device was designed. Postoperatively, at the 12-week mark, manual palpation was employed to compare the interbody fusion status among Groups B, C, D, and E. Specimens from Groups C, D, and E were subjected to Micro-CT scanning to compare various parameters such as trabecular bone volume (BV), bone volume fraction (BV/TV, BVF), and bone surface area (BS). Furthermore, a tissue histopathological examination was performed to observe the structure and morphology of newly formed bone within the fusion mass as well as the remodeling of the graft in each group. RESULTS Based on the measurements obtained from the dissection group, we designed a U-shaped interbody fusion device with dimensions of 10 mm in length, 2.5 mm in width, and 1.3 mm in height. In Group B, 9 cases exhibited intervertebral mobility. In Group C, 1 case showed nonfusion. In Group D, all cases achieved fusion. In Group E, 4 cases did not achieve fusion. Additionally, the Micro-CT results showed that the interbody fusion index scores were 4.64±0.50 in Group C, 4.33±0.65 in Group D, and 3.36±0.81 in Group E. There was no statistically significant difference in fusion index scores between Groups C and D (p=.853). Notably, Groups C and D had higher scores than Group E (p<.001). The trabecular bone volume (BV) in Groups C and D also showed no significant difference but was significantly higher than in Group E (p<.001). Furthermore, the histopathological results revealed that the specimens from Group E had less newly formed cartilage and bone compared to Groups C and D. CONCLUSIONS This study successfully established a strict simulation of the clinical LLIF procedure in a rabbit model. Moreso, we conducted a preliminary validation indicating that the BMP-2 carrier material achieved interbody fusion outcomes similar to autogenous iliac bone. CLINICAL SIGNIFICANCE The findings of this investigation from animal models provide a theoretical basis for the clinical use of BMP-2 to promote early spinal fusion in LLIF procedures. Importantly, the study provides a small animal model foundation for research related to LLIF surgery.
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Affiliation(s)
- Jiaqi Li
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Bingyi Zhao
- Department of Reproductive and Genetic medicine, Hebei General Hospital, Shijiazhuang, 050000, China
| | - Weijian Wang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Yafei Xu
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Haoyu Wu
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Wei Zhang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050000, China.
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Shukla G, Matur AV, Tao X, Khalid S, Garner R, Gibson J, Cass D, Wu A, Street S, Garcia-Vargas J, Mehta J, Childress K, Duah HO, Motley B, Cheng J, Adogwa O. Synthetic Interbody Devices and Traditional Bone Graft Are Associated With a Similar Rate of Surgical Complications After 1-2 Level Anterior Cervical Discectomy and Fusions. Spine (Phila Pa 1976) 2024; 49:615-620. [PMID: 37661823 DOI: 10.1097/brs.0000000000004819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/24/2023] [Indexed: 09/05/2023]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE To compare the rates of all-cause surgical complications of synthetic interbody devices versus allograft or autograft in patients undergoing 1-2 levels anterior cervical discectomy and fusion (ACDF) procedures. SUMMARY OF BACKGROUND DATA Cervical degenerative disorders affect up to 60% of older adults in the United States. Both traditional allograft or autograft and synthetic interbody devices (polyetheretherketone or titanium) are used for decompression and arthrodesis, with increasing utilization of the latter. However, the differences in their postsurgical complication profiles are not well-characterized. PATIENTS AND METHODS Patients who underwent 1-2 level ACDFs for cervical radiculopathy or myelopathy between 2010 and 2022 were identified using the PearlDiver Mariner all-claims insurance database. Patients undergoing surgery for nondegenerative pathologies, such as tumors, trauma, or infection, were excluded. 1:1 exact matching was performed based on factors that were significant predictors of all-cause surgical complications in a linear regression model. The primary outcome measure was the development of all-cause surgical complications after 1-2 level ACDFs. The secondary outcome was all-cause medical complications. RESULTS 1:1 exact matching resulted in two equal groups of 11,430 patients who received treatment with synthetic interbody devices or allograft/autograft. No statistically significant difference in all-cause surgical complications was found between the synthetic cohort and the allograft or autograft cohort after 1-2 level ACDFs (Relative Risk: 0.86, 95% confidence interval: 0.730-1.014, P = 0.079). No significant differences were observed regarding any specific surgical complications except for pseudoarthrosis (Relative Risk: 0.73, 95% confidence interval: 0.554-0.974, P = 0.037), which was higher in the allograft/autograft cohort. CONCLUSION After 1:1 exact matching to control for confounding variables, the findings of this study suggest that all-cause surgical complications are similar in patients undergoing ACDFs with synthetic interbody devices or allograft/autographs. However, the rate of pseudarthrosis appears to be higher in patients with allograft/autographs. Future prospective studies are needed to corroborate these findings.
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Affiliation(s)
- Geet Shukla
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Abhijith V Matur
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Xu Tao
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Syed Khalid
- Department of Neurosurgery, University of Illinois, Chicago, IL
| | - Rebecca Garner
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Justin Gibson
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Daryn Cass
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Andrew Wu
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Seth Street
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Julia Garcia-Vargas
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jay Mehta
- Department of Environmental and Public Health Sciences, University of Cincinnati, Cincinnati, OH
| | - Kelly Childress
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Henry O Duah
- Institute for Nursing Research and Scholarship, University of Cincinnati College of Nursing, Cincinnati, OH
| | - Benjamin Motley
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Joseph Cheng
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
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Liu X, Astudillo Potes MD, Serdiuk V, Dashtdar B, Schreiber AC, Rezaei A, Lee Miller A, Hamouda AM, Shafi M, Elder BD, Lu L. Injectable bioactive poly(propylene fumarate) and polycaprolactone based click chemistry bone cement for spinal fusion in rabbits. J Biomed Mater Res A 2024. [PMID: 38644548 DOI: 10.1002/jbm.a.37725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 04/23/2024]
Abstract
Degenerative spinal pathology is a widespread medical issue, and spine fusion surgeries are frequently performed. In this study, we fabricated an injectable bioactive click chemistry polymer cement for use in spinal fusion and bone regrowth. Taking advantages of the bioorthogonal click reaction, this cement can be crosslinked by itself eliminating the addition of a toxic initiator or catalyst, nor any external energy sources like UV light or heat. Furthermore, nano-hydroxyapatite (nHA) and microspheres carrying recombinant human bone morphogenetic protein-2 (rhBMP-2) and recombinant human vascular endothelial growth factor (rhVEGF) were used to make the cement bioactive for vascular induction and osteointegration. After implantation into a rabbit posterolateral spinal fusion (PLF) model, the cement showed excellent induction of new bone formation and bridging bone, achieving results comparable to autograft control. This is largely due to the osteogenic properties of nano-hydroxyapatite (nHA) and the released rhBMP-2 and rhVEGF growth factors. Since the availability of autograft sources is limited in clinical settings, this injectable bioactive click chemistry cement may be a promising alternative for spine fusion applications in addressing various spinal conditions.
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Affiliation(s)
- Xifeng Liu
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Maria D Astudillo Potes
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Vitalii Serdiuk
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Babak Dashtdar
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Areonna C Schreiber
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Asghar Rezaei
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - A Lee Miller
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Mahnoor Shafi
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Benjamin D Elder
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Lichun Lu
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Fu TS, Chen WC, Wang YC, Chang CW, Lin TY, Wong CB. Biomimetic vascularized adipose-derived mesenchymal stem cells bone-periosteum graft enhances angiogenesis and osteogenesis in a male rabbit spine fusion model. Bone Joint Res 2023; 12:722-733. [PMID: 38052231 DOI: 10.1302/2046-3758.1212.bjr-2023-0013.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
Aims Several artificial bone grafts have been developed but fail to achieve anticipated osteogenesis due to their insufficient neovascularization capacity and periosteum support. This study aimed to develop a vascularized bone-periosteum construct (VBPC) to provide better angiogenesis and osteogenesis for bone regeneration. Methods A total of 24 male New Zealand white rabbits were divided into four groups according to the experimental materials. Allogenic adipose-derived mesenchymal stem cells (AMSCs) were cultured and seeded evenly in the collagen/chitosan sheet to form cell sheet as periosteum. Simultaneously, allogenic AMSCs were seeded onto alginate beads and were cultured to differentiate to endothelial-like cells to form vascularized bone construct (VBC). The cell sheet was wrapped onto VBC to create a vascularized bone-periosteum construct (VBPC). Four different experimental materials - acellular construct, VBC, non-vascularized bone-periosteum construct, and VBPC - were then implanted in bilateral L4-L5 intertransverse space. At 12 weeks post-surgery, the bone-forming capacities were determined by CT, biomechanical testing, histology, and immunohistochemistry staining analyses. Results At 12 weeks, the VBPC group significantly increased new bone formation volume compared with the other groups. Biomechanical testing demonstrated higher torque strength in the VBPC group. Notably, the haematoxylin and eosin, Masson's trichrome, and immunohistochemistry-stained histological results revealed that VBPC promoted neovascularization and new bone formation in the spine fusion areas. Conclusion The tissue-engineered VBPC showed great capability in promoting angiogenesis and osteogenesis in vivo. It may provide a novel approach to create a superior blood supply and nutritional environment to overcome the deficits of current artificial bone graft substitutes.
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Affiliation(s)
- Tsai-Sheng Fu
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Chuan Chen
- Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan, Taiwan
| | - Ying-Chih Wang
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Wei Chang
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tung-Yi Lin
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chak-Bor Wong
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan, Taiwan
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Chalamgari A, Valle D, Palau Villarreal X, Foreman M, Liu A, Patel A, Dave A, Lucke-Wold B. Vertebral Primary Bone Lesions: Review of Management Options. Curr Oncol 2023; 30:3064-3078. [PMID: 36975445 PMCID: PMC10047554 DOI: 10.3390/curroncol30030232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 02/26/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023] Open
Abstract
The assessment and treatment of vertebral primary bone lesions continue to pose a unique yet significant challenge. Indeed, there exists little in the literature in the way of compiling and overviewing the various types of vertebral lesions, which can often have complicated intervention strategies. Given the severe consequences of mismanaged vertebral bone tumors-including the extreme loss of motor function-it is clear that such an overview of spinal lesion care is needed. Thus, in the following paper, we aim to address the assessment of various vertebral primary bone lesions, outlining the relevant nonsurgical and surgical interventional methods. We describe examples of primary benign and malignant tumors, comparing and contrasting their differences. We also highlight emerging treatments and approaches for these tumors, like cryoablation and stereotactic body radiation therapy. Ultimately, we aim to emphasize the need for further guidelines in regard to correlating lesion type with proper therapy, underscoring the innate diversity of vertebral primary bone lesions in the literature.
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Affiliation(s)
| | | | | | | | | | | | | | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida College of Medicine, Gainesville, FL 32601, USA
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Lehr AM, Duits AA, Reijnders MR, Nutzinger D, Castelein RM, Oner FC, Kruyt MC. Assessment of Posterolateral Lumbar Fusion: A Systematic Review of Imaging-Based Fusion Criteria. JBJS Rev 2022; 10:01874474-202210000-00007. [PMID: 36325766 PMCID: PMC9612687 DOI: 10.2106/jbjs.rvw.22.00129] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Noninvasive assessment of osseous fusion after spinal fusion surgery is essential for timely diagnosis of patients with symptomatic pseudarthrosis and for evaluation of the performance of spinal fusion procedures. There is, however, no consensus on the definition and assessment of successful posterolateral fusion (PLF) of the lumbar spine. This systematic review aimed to (1) summarize the criteria used for imaging-based fusion assessment after instrumented PLF and (2) evaluate their diagnostic accuracy and reliability. METHODS First, a search of the literature was conducted in November 2018 to identify reproducible criteria for imaging-based fusion assessment after primary instrumented PLF between T10 and S1 in adult patients, and to determine their frequency of use. A second search in July 2021 was directed at primary studies on the diagnostic accuracy (with surgical exploration as the reference) and/or reliability (interobserver and intraobserver agreement) of these criteria. Article selection and data extraction were performed by at least 2 reviewers independently. The methodological quality of validation studies was assessed with the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2) and QAREL (Quality Appraisal of Reliability Studies). RESULTS Of the 187 articles included from the first search, 47% used a classification system and 63% used ≥1 descriptive criterion related to osseous bridging (104 articles), absence of motion (78 articles), and/or absence of static signs of nonunion (39 articles). A great variation in terminology, cutoff values, and assessed anatomical locations was observed. While the use of computed tomography (CT) increased over time, radiographs remained predominant. The second search yielded 11 articles with considerable variation in outcomes and quality concerns. Agreement between imaging-based assessment and surgical exploration with regard to demonstration of fusion ranged between 55% and 80%, while reliability ranged from poor to excellent. CONCLUSIONS None of the available criteria for noninvasive assessment of fusion status after instrumented PLF were demonstrated to have both sufficient accuracy and reliability. Further elaboration and validation of a well-defined systematic CT-based assessment method that allows grading of the intertransverse and interfacet fusion mass at each side of each fusion level and includes signs of nonunion is recommended. LEVEL OF EVIDENCE Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- A. Mechteld Lehr
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands,Email for corresponding author:
| | - Anneli A.A. Duits
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maarten R.L. Reijnders
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Don Nutzinger
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - René M. Castelein
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - F. Cumhur Oner
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Moyo C. Kruyt
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Zhang CL, Song DJ, Zhang LD, Liu L, Zhu BL. Research on Mechanism of Nanometric Bone Pulp Activated with Double Gene as Bone Morphogenetic Protein 1 and Vascular Endothelial Growth Factor for Improving the Strength of Centrum in Osteoporosis. J Biomed Nanotechnol 2022; 18:1035-1043. [PMID: 35854465 DOI: 10.1166/jbn.2022.3312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The aim of this study was assessing the mechanism of nanometric bone pulp activated with double gene as bone morphogenetic protein 1 (BMP-1) and vascular endothelial growth factor (VEGF) in improving the strength of centrum in osteoporosis (OP). The model of nanometric bone pulp activated with BMP-1 and VEGF double gene was established and validated. Under maximum condition of load and collapsed fragments, the model was analyzed through biomechanical test. The conditions for ALP, BGP, MLL and BMD in the model were also analyzed, and three-dimensional structural transformation was analyzed. Western blot and qRT-PCR were used to detect the effect of adding or not adding dual gene activated nano-bone stickers on OC-specific protein and mRNA; ELISA kits were used to detect the changes of RANKL pathway RANKL, OPG and TRACP5b. The maximum conformed quality and condensed intensity were strengthened with the nanometric bone pulp activated with BMP-1 and VEGF double gene. The maximum load in centrum was extremely elevated in the model, and the condition of ALP and its effect on bone was partly improved in the model. The precision and efficiency in the quality of BMD were continuously decreased. The BMD and MLF were strengthened notably in the model, and their effect on the bone was extremely improved. There was tight displayed model of trabecular in centrum and porosity was also continuously reduced. After adding the double-gene activated nano-bone stickers, the results from qRTPCR and Western blot showed that the changes of osteoclast-related genes and protein expressions were significantly down-regulated. The nanometric bone pulp activated with BMP-1 and VEGF double gene was one of ideal filled criterion. The BMD and bone strength were also elevated.
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Affiliation(s)
- Cheng-Liang Zhang
- Department of Orthopedics, The Affiliated Shuyang Hospital of Xuzhou Medical University, Shuyang County, Jiangsu Province, 223600, China
| | - Da-Jiang Song
- Department of Orthopedics, The Affiliated Shuyang Hospital of Xuzhou Medical University, Shuyang County, Jiangsu Province, 223600, China
| | - Li-Dong Zhang
- Department of Orthopedics, The Affiliated Shuyang Hospital of Xuzhou Medical University, Shuyang County, Jiangsu Province, 223600, China
| | - Lei Liu
- Department of Orthopedics, The Affiliated Shuyang Hospital of Xuzhou Medical University, Shuyang County, Jiangsu Province, 223600, China
| | - Bao-Lin Zhu
- Department of Orthopedics, The Affiliated Shuyang Hospital of Xuzhou Medical University, Shuyang County, Jiangsu Province, 223600, China
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Anterior debridement, bone grafting and fixation for cervical spine tuberculosis: an iliac bone graft versus a structural manubrium graft. BMC Musculoskelet Disord 2022; 23:236. [PMID: 35277155 PMCID: PMC8915494 DOI: 10.1186/s12891-022-05177-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 03/03/2022] [Indexed: 11/30/2022] Open
Abstract
Background Anterior debridement, decompression, bone grafting, and instrumentation are safe and effective techniques for patients with lower cervical spine tuberculosis. However, there is no consensus regarding the methods for using autogenous bone grafts. The purpose of this retrospective study was to compare the clinical outcomes of anterior surgical management for cervical spine tuberculosis by using an iliac bone graft versus a structural manubrium graft. Methods From January 2009 to September 2018, 23 patients with cervical spine tuberculosis were treated with anterior debridement, autogenous structural bone grafting and fixation at our spinal department. The patients were divided into 2 groups according to the different graft materials, namely, iliac crest bone grafts (Group A) and structural manubrium grafts (Group B). The clinical and radiographic results of the 2 groups were analyzed and compared. Results The mean duration of follow-up was 24 months. Bony fusion was achieved in all patients without failure of internal fixation. There were no significant differences between the two groups with respect to the operation time, blood loss, fusion time, neurological outcomes, or postoperative local Cobb angle (P > .05). However, the donor site complication rate in Group A was greater than that in Group B. The postoperative ambulation time in Group A was later than that in Group B. The mean visual analog scale (VAS) score for donor site pain in Group A was higher than that in Group B at 1 week after surgery (P < 0.05). However, there was no significant difference between the 2 groups at the last visit (P > .05). Conclusion Both iliac bone grafts and sternal manubrium grafts can effectively reconstruct anterior column defects in anterior surgery. However, structural sternal manubrium autografts cause fewer complications associated with donor site morbidities than iliac bone grafts.
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Han G, Zou D, Liu Z, Zhang B, Gong C, Zhou S, Li W, Sun Z, Li W. Fat infiltration of paraspinal muscles as an independent risk for bone nonunion after posterior lumbar interbody fusion. BMC Musculoskelet Disord 2022; 23:232. [PMID: 35264133 PMCID: PMC8908625 DOI: 10.1186/s12891-022-05178-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 03/02/2022] [Indexed: 12/15/2022] Open
Abstract
Background The prognosis value of paraspinal muscle degeneration on clinical outcomes has been revealed. However no study has investigated the effect of the fat infiltration (FI) of paraspinal muscles on bone nonunion after posterior lumbar interbody fusion (PLIF). Methods Three hundred fifty-one patients undergoing PLIF for lumbar spinal stenosis with 1-year follow-up were retrospectively identified. Patients were categorized into bone union (n = 301) and bone nonunion (n = 50) groups based on dynamic X-ray at 1-year follow-up. The relative total cross-sectional area (rTCSA) and FI of multifidus (MF) and erector spinae (ES), and the relative functional CSA (rFCSA) of psoas major (PS) were measured on preoperative magnetic resonance imaging. Results The nonunion group had a significantly higher MF FI and a higher ES FI and a smaller MF rTCSA than the union group (p = 0.001, 0.038, 0.026, respectively). Binary logistic regression revealed that MF FI (p = 0.029, odds ratio [OR] = 1.04), lumbosacral fusion (p = 0.026, OR = 2193) and length of fusion (p = 0.001, OR = 1.99) were independent factors of bone nonunion. In subgroup analysis, in one or two-level fusion group, the patients with nonunion had a higher MF FI and a higher ES FI than those of the patients with union (all p < 0.05). Similarly, in lumbosacral fusion group, the patients with nonunion had a higher MF FI and a higher ES FI than those of the patients with union (all p < 0.05). The logistic regressions showed that MF FI remained an independent factor of bone nonunion both in the patients with one or two-level fusion (p = 0.003, OR = 1.074) and in the patients with lumbosacral fusion (p = 0.006, OR = 1.073). Conclusions Higher fatty degeneration was strongly associated with bone nonunion after PLIF. Surgeons should pay attention to the FI of paraspinal muscles when performing posterior surgery for patients, especially those who need short-segment fusion or to extend fusion to S1. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05178-z.
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Affiliation(s)
- Gengyu Han
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China.,Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Da Zou
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China.,Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Zexiang Liu
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China
| | - Bo Zhang
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China
| | - Chunjie Gong
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China
| | - Siyu Zhou
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China.,Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Wei Li
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China.,Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Zhuoran Sun
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China.,Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, No. 49 NorthGarden Road, Haidian District, Beijing, 100191, China. .,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China. .,Beijing Key Laboratory of Spinal Disease Research, Beijing, China.
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10
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O’Neill CN, Walterscheid ZJ, Carmouche JJ. A Novel Local Cancellous Autograft Source for Anterior Cervical Discectomy With Fusion. Global Spine J 2022; 12:190-197. [PMID: 32990036 PMCID: PMC8907638 DOI: 10.1177/2192568220947741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
STUDY DESIGN Case series. OBJECTIVES Successful clinical outcome scores following anterior cervical discectomy and fusion (ACDF) have been correlated with high fusion rate. Published fusion rates using iliac crest bone graft (ICBG) have been shown to be as high as 100% for single-level fusions in some studies; however, there is potential associated morbidity with ICBG harvest. This technical description and preliminary case series assessed the clinical efficacy and results of a novel grafting technique for ACDF. METHODS Twelve patients underwent novel grafting technique for ACDF in which autograft was procured from the cervical vertebra adjacent to the operative disk. Patients were followed for 2 years using visual analogue pain scale (VAS) and radiological assessment of fusion. RESULTS Patients experienced clinically meaningful reduction of radicular symptoms in the affected arm(s) with an average preoperative VAS score of 5.0 ± 0.8 and an average 2-year postoperative score of 1.108 ± 0.475 (P = .0013). Patients also experienced significant resolution of neck pain with an average preoperative VAS score of 7.1 ± 0.5 and average 2-year postoperative score of 2.708 ± 0.861 (P = .0018). All patients achieved solid fusion by 1 year. There were no major or minor complications noted during follow-up. CONCLUSIONS This procedure allows for both autograft harvest and cervical decompression to be performed through a single incision. In this series, this technique eliminated the morbidity associated with autograft harvest from the iliac crest while achieving high fusion rates and without additional technique-related complications.
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Affiliation(s)
| | | | - Jonathan J. Carmouche
- Virginia Tech-Carilion School or
Medicine, Roanoke VA, USA,Carilion Clinic, Roanoke VA,
USA,Jonathan Carmouche, Carilion Clinic, 2331
Franklin Rd SW, Roanoke, VA 24014, USA.
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11
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Zhang Y, Jiang Y, Zou D, Yuan B, Ke HZ, Li W. Therapeutics for enhancement of spinal fusion: A mini review. J Orthop Translat 2021; 31:73-79. [PMID: 34934624 DOI: 10.1016/j.jot.2021.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 10/19/2022] Open
Abstract
Objective With the advances in biological technologies over the past 20 years, a number of new therapies to promote bone healing have been introduced. Particularly in the spinal surgery field, more unprecedented biological therapeutics become available to enhance spinal fusion success rate along with advanced instrumentation approaches. Yet surgeons may not have been well informed about their safety and efficacy profiles in order to improve clinical practices. Therefore there is a need to summarize the evidence and bring the latest progress to surgeons for better clinical services for patients. Methods We comprehensively reviewed the literatures in regard to the biological therapeutics for enhancement of spinal fusion published in the last two decades. Results Autograft bone is still the gold standard for bone grafting in spinal fusion surgery due to its good osteoconductive, osteoinductive, and osteogenic abilities. Accumulating evidence suggests that adding rhBMPs in combination with autograft effectively promotes the fusion rate and improves surgical outcomes. However, the stimulating effect on spinal fusion of other growth factors, including PDGF, VEGF, TGF-beta, and FGF, is not convincing, while Nell-1 and activin A exhibited preliminary efficacy. In terms of systemic therapeutic approaches, the osteoporosis drug Teriparatide has played a positive role in promoting bone healing after spinal surgery, while new medications such as denosumab and sclerostin antibodies still need further validation. Currently, other treatment, such as controlled-release formulations and carriers, are being studied for better releasing profile and the administration convenience of the active ingredients. Conclusion As the world's population continues to grow older, the number of spinal fusion cases grows substantially due to increased surgical needs for spinal degenerative disease (SDD). Critical advancements in biological therapeutics that promote spinal fusion have brought better clinical outcomes to patients lately. With the accumulation of higher-level evidence, the safety and efficacy of present and emerging products are becoming more evident. These emerging therapeutics will shift the landscape of perioperative therapy for the enhancement of spinal fusion.
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Affiliation(s)
- Yidan Zhang
- Angitia Biopharmaceuticals, Guangzhou, China
| | - Yu Jiang
- Orthopaedic Department, Peking University Third Hospital, Beijing, China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
| | - Da Zou
- Orthopaedic Department, Peking University Third Hospital, Beijing, China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
| | - Baozhi Yuan
- Angitia Biopharmaceuticals, Guangzhou, China
| | - Hua Zhu Ke
- Angitia Biopharmaceuticals, Guangzhou, China
| | - Weishi Li
- Orthopaedic Department, Peking University Third Hospital, Beijing, China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
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12
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DEMİREL C, TÜRKÖZ D, YİLMAZ T. Experimental Comparison of Autograft and DBM Flex (Grafton) for Spinal Lumbar Fusion in Rabbits. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2021. [DOI: 10.25000/acem.963125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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13
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Shin JJ, Kim KR, Son DW, Shin DA, Yi S, Kim KN, Yoon DH, Ha Y, Riew KD. Cervical disc arthroplasty: What we know in 2020 and a literature review. J Orthop Surg (Hong Kong) 2021; 29:23094990211006934. [PMID: 34581615 DOI: 10.1177/23094990211006934] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Cervical disc arthroplasty (CDA) is a safe and effective option to improve clinical outcomes (e.g., NDI, VAS, and JOA) in degenerative cervical disc disease and compressive myelopathy. CDA's two main purported benefits have been that it maintains physiologic motion and thereby minimizes the biomechanical stresses placed on adjacent segments as compared to an ACDF. CDA might reduce the degeneration of adjacent segments, and the need for adjacent-level surgery. Reoperation rates of CDA have been reported to range from 1.8% to 5.4%, with a minimum 5-year follow-up. As the number of CDA procedures performed continues to increase, the need for revision surgery is also likely to increase. When performed skillfully in appropriate patients, CDA is an effective surgical technique to optimize clinical outcomes and radiological results. This review may assist surgical decision-making and enable a more effective and safer implementation of cervical arthroplasty for cervical degenerative disease.
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Affiliation(s)
- Jun Jae Shin
- Department of Neurosurgery, Yongin Severance Hospital, 37991Yonsei University School of Medicine, Yongin, Korea
| | - Kwang-Ryeol Kim
- Department of Neurosurgery, International St Mary's Hospital, 54671Catholic Kwandong University, College of Medicine, Incheon, Korea
| | - Dong Wuk Son
- Department of Neurosurgery, 194197Pusan National University Yangsan Hospital, School of Medicine, Yangsan, Korea
| | - Dong Ah Shin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, 37991Yonsei University College of Medicine, Seoul, Korea
| | - Seong Yi
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, 37991Yonsei University College of Medicine, Seoul, Korea
| | - Keung-Nyun Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, 37991Yonsei University College of Medicine, Seoul, Korea
| | - Do-Heum Yoon
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, 37991Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, 37991Yonsei University College of Medicine, Seoul, Korea.,POSTECH Biotech Center, Pohang University of Science and Technology, Pohang, Gyeongbuk, Korea
| | - K Daniel Riew
- Department of Orthopedic Surgery, 5798Columbia University College of Physicians and Surgeons, New York, NY, USA.,Department of Neurological Surgery, Weill Cornell Medical College, Cornell University, New York, NY, USA
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14
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Liu H, Zhu H, Cheng L, Zhao Y, Chen X, Li J, Xv X, Xiao Z, Li W, Pan J, Zhang Q, Zeng C, Guo J, Xie D, Cai D. TCP/PLGA composite scaffold loaded rapamycin in situ enhances lumbar fusion by regulating osteoblast and osteoclast activity. J Tissue Eng Regen Med 2021; 15:475-486. [PMID: 33686790 DOI: 10.1002/term.3186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 02/22/2021] [Indexed: 11/07/2022]
Abstract
The purpose of this study was to develop a novel β-tricalcium phosphate (TCP)/poly (D,L-lactic-co-glycolic acid) (PLGA) composite scaffold loaded with rapamycin that can regulate the activity of osteoblasts and osteoclasts for lumbar fusion. The TCP/PLGA composite scaffold was fabricated by cryogenic three-dimensional printing techniques and then loaded with rapamycin in situ. The structural surface morphology of the composite scaffold was tested with scanning electron microscope. To evaluate the biocompatibility of the composite scaffold in vitro, bone marrow mesenchymal stem cells (BMSCs) were cultured on the TCP/PLGA composite scaffold slide and tested with Live/Dead Viability Kit. The effect of rapamycin on osteoclast and osteoblast was studied with staining and Western blotting. The in vitro results showed that the rapamycin-loaded TCP/PLGA composite scaffold showed good biocompatibility with BMSC and released rapamycin obviously promoted the osteoblast differentiation and mineralization. In vivo study, the TCP/PLGA composite scaffold loaded with rapamycin were implanted in lumbar fusion model and study with micro-computed tomography scanning, hematoxylin-eosin, Masson, and immune-histological staining, to evaluate the effect of rapamycin on bone fusion. The in vivo results demonstrated that rapamycin-loaded TCP/PLGA composite scaffold could enhance bone formation by regulating osteoblast and osteoclast activity, respectively. In this study, the TCP/PLGA composite scaffold loaded with rapamycin was confirmed to provide great compatibility and improved performance in lumbar fusion by regulating osteoblastic and osteoclastic activity and would be a promising composite biomaterial for bone tissue engineering.
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Affiliation(s)
- Hai Liu
- Department of Orthopaedic Surgery, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Huangrong Zhu
- Department of Orthopaedic Surgery, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Liang Cheng
- Department of Orthopaedic Surgery, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Yitao Zhao
- Department of Orthopaedic Surgery, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Xizhong Chen
- Department of Orthopaedic Surgery, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Jintao Li
- Department of Orthopaedic Surgery, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Xin Xv
- Department of Orthopaedic Surgery, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Zhisheng Xiao
- Department of Orthopaedic Surgery, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Wei Li
- Department of Orthopaedic Surgery, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Jianying Pan
- Department of Orthopaedic Surgery, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Qun Zhang
- Department of Orthopaedic Surgery, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
- Office of Clinical Trial of Drug, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Chun Zeng
- Department of Orthopaedic Surgery, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Jinshan Guo
- Department of Orthopaedic Surgery, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
- Department of Histology and Embryology, School of Basic Medical Science, Southern Medical University, Guangzhou, Guangdong, China
| | - Denghui Xie
- Department of Orthopaedic Surgery, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Daozhang Cai
- Department of Orthopaedic Surgery, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
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15
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Tenpenny W, Caldwell PE, Rivera-Rosado E, Pearson SE. Arthroscopic-Assisted Bone Graft Harvest From the Proximal Humerus for Distal Third Clavicle Fracture Nonunion. Arthrosc Tech 2020; 9:e1937-e1942. [PMID: 33381403 PMCID: PMC7768109 DOI: 10.1016/j.eats.2020.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 08/20/2020] [Indexed: 02/03/2023] Open
Abstract
Clavicle fracture nonunion can lead to persistent pain and loss of shoulder function. Distal clavicle fractures have the greatest risk of nonunion and are often treated surgically. Bone grafting plays a vital role in the treatment of distal clavicle nonunion. Although multiple options for bone graft exist, the iliac crest has long been considered the gold standard for harvest. Despite its extensive use, multiple complications have been associated with iliac crest bone graft harvest. We advocate a surgical technique for arthroscopic bone graft harvest from the proximal humerus with open reduction and internal fixation of an ipsilateral distal clavicle nonunion.
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Affiliation(s)
| | - Paul E. Caldwell
- Orthopaedic Research of Virginia, Richmond, Virginia, U.S.A.,Tuckahoe Orthopaedic Associates, Ltd., Richmond, Virginia, U.S.A.,Address correspondence to Paul E. Caldwell, III, M.D., 1501 Maple Ave., Suite 200, Richmond, VA 23226.
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16
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Shum LC, Hollenberg AM, Baldwin AL, Kalicharan BH, Maqsoodi N, Rubery PT, Mesfin A, Eliseev RA. Role of oxidative metabolism in osseointegration during spinal fusion. PLoS One 2020; 15:e0241998. [PMID: 33166330 PMCID: PMC7652281 DOI: 10.1371/journal.pone.0241998] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/24/2020] [Indexed: 12/05/2022] Open
Abstract
Spinal fusion is a commonly performed orthopedic surgery. Autologous bone graft obtained from the iliac crest is frequently employed to perform spinal fusion. Osteogenic bone marrow stromal (a.k.a. mesenchymal stem) cells (BMSCs) are believed to be responsible for new bone formation and development of the bridging bone during spinal fusion, as these cells are located in both the graft and at the site of fusion. Our previous work revealed the importance of mitochondrial oxidative metabolism in osteogenic differentiation of BMSCs. Our objective here was to determine the impact of BMSC oxidative metabolism on osseointegration of the graft during spinal fusion. The first part of the study was focused on correlating oxidative metabolism in bone graft BMSCs to radiographic outcomes of spinal fusion in human patients. The second part of the study was focused on mechanistically proving the role of BMSC oxidative metabolism in osseointegration during spinal fusion using a genetic mouse model. Patients’ iliac crest-derived graft BMSCs were identified by surface markers. Mitochondrial oxidative function was detected in BMSCs with the potentiometric probe, CMXRos. Spinal fusion radiographic outcomes, determined by the Lenke grade, were correlated to CMXRos signal in BMSCs. A genetic model of high oxidative metabolism, cyclophilin D knockout (CypD KO), was used to perform spinal fusion in mice. Graft osseointegration in mice was assessed with micro-computed tomography. Our study revealed that higher CMXRos signal in patients’ BMSCs correlated with a higher Lenke grade. Mice with higher oxidative metabolism (CypD KO) had greater mineralization of the spinal fusion bridge, as compared to the control mice. We therefore conclude that higher oxidative metabolism in BMSCs correlates with better spinal fusion outcomes in both human patients and in a mouse model. Altogether, our study suggests that promoting oxidative metabolism in osteogenic cells could improve spinal fusion outcomes for patients.
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Affiliation(s)
- Laura C. Shum
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Alex M. Hollenberg
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Avionna L. Baldwin
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Brianna H. Kalicharan
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Noorullah Maqsoodi
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Paul T. Rubery
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Addisu Mesfin
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Roman A. Eliseev
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, United States of America
- * E-mail:
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17
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Comparative Clinical Effectiveness and Safety of Bone Morphogenetic Protein Versus Autologous Iliac Crest Bone Graft in Lumbar Fusion: A Meta-analysis and Systematic Review. Spine (Phila Pa 1976) 2020; 45:E729-E741. [PMID: 31923133 PMCID: PMC7282484 DOI: 10.1097/brs.0000000000003372] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This is a systematic literature review and meta-analysis. OBJECTIVE We aimed to evaluate the efficacy and safety of recombinant human bone morphogenetic protein (RhBMP) and autologous iliac crest bone graft (ICBG) in lumbar fusion. SUMMARY OF BACKGROUND DATA RhBMP has been emphasized in lumbar fusion due to high fusion success rate. However, ICBG remains the criterion standard graft approach for lumbar fusion. The safety and effectiveness of rhBMP are controversial. METHODS Prospective randomized controlled trials were searched from PubMed, EMBASE, and Cochrane Central Register of Controlled Trails by using Medical Subject Headings terms "bone morphogenetic protein,' "bone transplantation,' and "spinal fusion.' Two independent investigators screened eligible studies, assessed the bias of original articles, extracted data including fusion success, Oswestry disability index improvement, improved short form 36 questionnaire scores, adverse events and re-operation, and a subgroup analysis. The GRADE approach was used to grade quality of evidence. RESULTS Twenty randomized controlled trials (2185 patients) met the inclusion criteria. There were higher fusion success rate (odds ratio [OR] 3.79, 95% confidence interval [CI] 1.88-7.63, P = 0.0002), better improvement of Oswestry Disability Index (mean difference 1.54, 95% CI 0.18-2.89, P = 0.03), and lower re-operation rate (OR 0.59, 95% CI 0.43-0.80, P = 0.0007) in rhBMP group. Heterogeneity was obvious in fusion success rate (I = 58%); hence, a subgroup analysis, based on protein type (rhBMP-2 or rhBMP-7), was performed, which suggested that only rhBMP-2 was better than ICBG for lumbar fusion. There was no difference in the incidence of adverse events between rhBMP and ICBG (OR 0.91, 95% CI 0.70-1.18, P = 0.47). CONCLUSION In lumbar fusion, rhBMP-2 exhibited a higher fusion success rate and reduced the risk of re-operation. No difference in complication rate is between rhBMP (rhBMP-2 and rhBMP-7) and ICBG. We suggest rhBMP especially rhBMP-2 as an effective substitute for ICBG for lumbar fusion. LEVEL OF EVIDENCE 1.
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18
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Lin C, Zhang N, Waldorff EI, Punsalan P, Wang D, Semler E, Ryaby JT, Yoo J, Johnstone B. Comparing cellular bone matrices for posterolateral spinal fusion in a rat model. JOR Spine 2020; 3:e1084. [PMID: 32613160 PMCID: PMC7323463 DOI: 10.1002/jsp2.1084] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/28/2020] [Accepted: 02/29/2020] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Cellular bone matrices (CBM) are allograft products that provide three components essential to new bone formation: an osteoconductive scaffold, extracellular growth factors for cell proliferation and differentiation, and viable cells with osteogenic potential. This is an emerging technology being applied to augment spinal fusion procedures as an alternative to autografts. METHODS We aim to compare the ability of six commercially-available human CBMs (Trinity ELITE®, ViviGen®, Cellentra®, Osteocel® Pro, Bio4® and Map3®) to form a stable spinal fusion using an athymic rat model of posterolateral fusion. Iliac crest bone from syngeneic rats was used as a control to approximate the human gold standard. The allografts were implanted at L4-5 according to vendor specifications in male athymic rats, with 15 rats in each group. MicroCT scans were performed at 48 hours and 6 weeks post-implantation. The rats were euthanized 6 weeks after surgery and the lumbar spines were harvested for X-ray, manual palpation and histology analysis by blinded reviewers. RESULTS By manual palpation, five of 15 rats of the syngeneic bone group were fused at 6 weeks. While Trinity ELITE had eight of 15 and Cellentra 11 of 15 rats with stable fusion, only 2 of 15 of ViviGen-implanted spines were fused and zero of 15 of the Osteocel Pro, Bio4 and Map3 produced stable fusion. MicroCT analysis indicated that total bone volume increased from day 0 to week 6 for all groups except syngeneic bone group. Trinity ELITE (65%) and Cellentra (73%) had significantly greater bone volume increases over all other implants, which was consistent with the histological analysis. CONCLUSION Trinity ELITE and Cellentra were significantly better than other implants at forming new bone and achieving spinal fusion in this rat model at week 6. These results suggest that there may be large differences in the ability of different CBMs to elicit a successful fusion in the posterolateral spine.
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Affiliation(s)
- Cliff Lin
- Department of Orthopaedics and RehabilitationOregon Health & Science UniversityPortlandOregonUSA
| | | | | | - Paolo Punsalan
- Department of Orthopaedics and RehabilitationOregon Health & Science UniversityPortlandOregonUSA
| | | | | | | | - Jung Yoo
- Department of Orthopaedics and RehabilitationOregon Health & Science UniversityPortlandOregonUSA
| | - Brian Johnstone
- Department of Orthopaedics and RehabilitationOregon Health & Science UniversityPortlandOregonUSA
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19
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Salamanna F, Tschon M, Borsari V, Pagani S, Martini L, Fini M. Spinal fusion procedures in the adult and young population: a systematic review on allogenic bone and synthetic grafts when compared to autologous bone. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2020; 31:51. [PMID: 32451687 DOI: 10.1007/s10856-020-06389-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 05/12/2020] [Indexed: 06/11/2023]
Abstract
This systematic review aims to compare clinical evidences related to autologous iliac crest bone graft (ICBG) and non-ICBG (local bone) with allografts and synthetic grafts for spinal fusion procedures in adult and young patients. A systematic search was carried out in three databases (PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials) to identify clinical studies in the last 10 years. The initial search retrieved 1085 studies, of which 24 were recognized eligible for the review. Twelve studies (4 RCTs, 5 prospective, 3 retrospective) were focused on lumbar spine, 9 (2 RCTs, 2 prospective, 4 retrospective, 1 case-series) on cervical spine and 3 (1 RCT, 2 retrospective) on spinal fusion procedures in young patients. Calcium phosphate ceramics, allografts, bioglasses, composites and polymers have been clinically investigated as substitutes of autologous bone in spinal fusion procedures. Of the 24 studies included in this review, only 1 RCT on cervical spine was classified with high level of evidence (Class I) and showed low risk of bias. This RCT demonstrated the safety and efficacy of the proposed treatment, a composite bone substitute, that results in similar and on some metrics superior outcomes compared with local autograft bone. Almost all other studies showed moderately or, more often, high incidence of bias (Class III), thus preventing ultimate conclusion on the hypothesized beneficial effects of allografts and synthetic grafts. This review suggests that users of allografts and synthetic grafting should carefully consider the scientific evidence concerning efficacy and safety of these bone substitutes, in order to select the best option for patient undergoing spinal fusion procedures.
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Affiliation(s)
- F Salamanna
- Laboratory of Preclinical and Surgical Studies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - M Tschon
- Laboratory of Preclinical and Surgical Studies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - V Borsari
- Laboratory of Preclinical and Surgical Studies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - S Pagani
- Laboratory of Preclinical and Surgical Studies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - L Martini
- Laboratory of Preclinical and Surgical Studies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - M Fini
- Laboratory of Preclinical and Surgical Studies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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20
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Johnstone B, Zhang N, Waldorff EI, Semler E, Dasgupta A, Betsch M, Punsalan P, Cho H, Ryaby JT, Yoo J. A Comparative Evaluation of Commercially Available Cell-Based Allografts in a Rat Spinal Fusion Model. Int J Spine Surg 2020; 14:213-221. [PMID: 32355628 DOI: 10.14444/7026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background To evaluate the comparative abilities of commercially available, viable, cellular bone allografts to promote posterolateral spinal fusion. Methods Human allografts containing live cells were implanted in the athymic rat model of posterolateral spine fusion. Three commercially available allogeneic cellular bone matrices (Trinity Evolution, Trinity ELITE and Osteocel Plus) were compared with syngeneic iliac crest bone as the control. All spines underwent radiographs, manual palpation, and micro-computed tomography (CT) analysis after excision at 6 weeks. Histological sections of randomly selected spines were subjected to semiquantitative histopathological scoring for bone formation. Results By manual palpation, posterolateral fusion was detected in 40% (6/15) of spines implanted with syngeneic bone, whereas spines implanted with Trinity Evolution and Trinity ELITE allografts yielded 71% (10/14) and 77% (10/13) fusion, respectively. Only 7% (1/14) of spines implanted with Osteocel Plus allografts were judged fused by manual palpation (statistically significantly less than ELITE, P < .0007, and Evolution, P < .0013). The mineralized cancellous bone component of the allografts confounded radiographic analysis, but Trinity Evolution (0.452 ± 0.064) and Trinity ELITE (0.536 ± 0.109) allografts produced statistically significantly higher bone fusion mass volumes measured by quantitative micro-CT than did syngeneic bone (0.292 ± 0.109, P < .0001 for ELITE and P < .003 for Evolution) and Osteocel Plus (0.258 ± 0.103, P < .0001). Semiquantitative histopathological scores supported these findings because the total bone and bone marrow scores reflected significantly better new bone and marrow formation in the Trinity groups than in the Osteocel Plus group. Conclusions The Trinity Evolution and Trinity ELITE cellular bone allografts were more effective at creating posterolateral fusion than either the Osteocel Plus allografts or syngeneic bone in this animal model. Clinical Relevance The superior fusion rate of Trinity cellular bone allografts may lead to better clinical outcome of spinal fusion surgeries.
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Affiliation(s)
- Brian Johnstone
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | | | | | | | | | - Marcel Betsch
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Paolo Punsalan
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Holly Cho
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | | | - Jung Yoo
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
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Park JB, Yang JH, Chang DG, Suk SI, Suh SW, Kim GU, Choi JY, Seo JY, Park HY, Kim SI, Kim YH, Ha KY. Comparison of Union Rates Between Autogenous Iliac Crest Bone Graft and Local Bone Graft as Fusion Materials in Lumbar Fusion Surgery: An Evaluation of Up to 3-Level Fusion. World Neurosurg 2020; 139:e286-e292. [PMID: 32294567 DOI: 10.1016/j.wneu.2020.03.211] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/27/2020] [Accepted: 03/29/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare the radiologic union rates between autogenous iliac crest bone graft (ICBG) and local bone graft in 1- to 3-level lumbar fusion. METHODS We reviewed 178 consecutive patients who underwent 1- to 3-level lumbar fusion surgery because of lumbar spinal stenosis. Fusion status of the anterior or posterior column was evaluated by plain radiographs obtained at 24 months postoperatively. If at least either the anterior or posterior column was fused, that segment was regarded as having achieved fusion and was termed segment union. The definition of overall union was achieving union of all segments in a single patient. RESULTS For each ICBG group and local bone graft group, fusion rate of the anterior and posterior column, and rate of the segments and overall union at postoperative 2 years were not different between the groups, regardless of surgery level. In the overall union rate according to the fusion level, the ICBG group showed constant overall fusion rate according to the fusion level (i.e., 96.9%, 96.9%, and 93.1% for 1-, 2-, and 3-level fusion), but tended to decrease with increasing level in the local bone graft group (100%, 95.8%, and 85.7% for 1-, 2-, and 3-level fusion, respectively) without statistically significant differences. CONCLUSIONS The union rate of 3-level fusion was not inferior to those of 1- or 2-level fusion in both ICBG and local bone graft patients. Local bone graft could be regarded as an adequate option for not only 1- or 2-level lumbar fusion but also 3-level lumbar fusion surgery.
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Affiliation(s)
- Jong-Beom Park
- Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Hyuk Yang
- Department of Orthopedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Korea
| | - Dong-Gune Chang
- Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Seoul, Korea.
| | - Se-Il Suk
- Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Seoul, Korea
| | - Seung-Woo Suh
- Department of Orthopedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Korea
| | - Gang-Un Kim
- Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Seoul, Korea
| | - Jung Yun Choi
- Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Seoul, Korea
| | - Jun-Yeong Seo
- Department of Orthopedic Surgery, St. Mary's Goodheal Orthopaedics, Seoul, Korea
| | - Hyung-Youl Park
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang-Il Kim
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young-Hoon Kim
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kee-Yong Ha
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Smith KA, Russo GS, Vaccaro AR, Arnold PM. Scientific, Clinical, Regulatory, and Economic Aspects of Choosing Bone Graft/Biological Options in Spine Surgery. Neurosurgery 2020; 84:827-835. [PMID: 30032187 DOI: 10.1093/neuros/nyy322] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/17/2018] [Indexed: 01/07/2023] Open
Abstract
Spinal arthrodesis is a major element of the spinal surgeon's practice. To attain successful fusion rates, attention must be paid to spinal segment immobilization and proper selection of bone graft. Autogenous bone graft (ie, ICBG), the "gold standard," with or without graft extenders and enhancers provides the foundation for most spinal fusions. ABG is the only graft option containing all 3 factors of new bone growth: osteoconductivity, osteoinductivity, and osteogenicity. While many bone graft alternatives function well as bone graft extenders, only growth factors proteins (ie, rhBMP-2 or OP-2) function as bone graft enhancers and substitutes. The search for optimal hybrid interbody cages, bone graft substitutes, autogenous or allogenic stem cells, and nanostructure scaffolds for release of growth factors continues.
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Affiliation(s)
- Kyle A Smith
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Glenn S Russo
- Department of Orthopedics, Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Alexander R Vaccaro
- Department of Orthopedics, Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Paul M Arnold
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas
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Ding X, Li A, Yang F, Sun K, Sun X. β-tricalcium phosphate and octacalcium phosphate composite bioceramic material for bone tissue engineering. J Biomater Appl 2020; 34:1294-1299. [PMID: 32028822 DOI: 10.1177/0885328220903989] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Xinxin Ding
- Key Laboratory of Liquid-Solid Structure Evolution and Processing of Materials, Ministry of Education, School of Materials Science and Engineering, Shandong University, Jinan, China.,Shandong Provincial Key Laboratory of Engineering Ceramics, School of Materials Science and Engineering, Shandong University, Jinan, China
| | - Aimin Li
- Key Laboratory of Liquid-Solid Structure Evolution and Processing of Materials, Ministry of Education, School of Materials Science and Engineering, Shandong University, Jinan, China.,Shandong Provincial Key Laboratory of Engineering Ceramics, School of Materials Science and Engineering, Shandong University, Jinan, China
| | - Fushuai Yang
- Key Laboratory of Liquid-Solid Structure Evolution and Processing of Materials, Ministry of Education, School of Materials Science and Engineering, Shandong University, Jinan, China.,Shandong Provincial Key Laboratory of Engineering Ceramics, School of Materials Science and Engineering, Shandong University, Jinan, China
| | - Kangning Sun
- Key Laboratory of Liquid-Solid Structure Evolution and Processing of Materials, Ministry of Education, School of Materials Science and Engineering, Shandong University, Jinan, China.,Shandong Provincial Key Laboratory of Engineering Ceramics, School of Materials Science and Engineering, Shandong University, Jinan, China
| | - Xiaoning Sun
- Key Laboratory of Liquid-Solid Structure Evolution and Processing of Materials, Ministry of Education, School of Materials Science and Engineering, Shandong University, Jinan, China.,Shandong Provincial Key Laboratory of Engineering Ceramics, School of Materials Science and Engineering, Shandong University, Jinan, China
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Park JS, Park SJ, Lee CS, Chung SS, Park HJ. Is allograft a more reliable treatment option than autograft in 2-level anterior cervical discectomy and fusion with plate fixation? Medicine (Baltimore) 2019; 98:e16621. [PMID: 31393360 PMCID: PMC6709247 DOI: 10.1097/md.0000000000016621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study aimed to assess the efficacy of allograft in 2-level anterior cervical discectomy and fusion (ACDF) with plate fixation by comparing its clinical and radiological outcomes to those of autograft.Thirty five patients with femur cortical allografts and 32 patients with tricortical iliac autografts were evaluated. All surgeries were performed by a single senior surgeon. During routine follow-up (at 3 months, 6 months, and annually after the surgery), the fusion rate, subsidence rate, and fused segmental lordosis angle were assessed by radiologic evaluation. Clinical outcomes were assessed using the visual analog scale (VAS), neck disability index (NDI) scores, and Odom criteria. This study was conducted using the results of the 2-year postoperative follow-up.Among 67 patients, 62 (92.5%) showed successful bone fusion at 2 years postoperatively: 91.4% (32/35) in the allograft group and 93.8% (30/32) in the autograft group. The fusion rate was 37.1% (13/35) in the allograft group and 68.8% (23/32) in the autograft group at 6 months and 68.5% (24/35) in the allograft group and 93.8% (30/32) in autograft group at 1 year. Eight (72.7%) of the remaining 11 patients with allograft achieved bone fusion without any intervention at the 2-year follow-up. The fusion was achieved faster in the autograft group than in the allograft group (P = .003). There was no significant difference in the subsidence rate or change in the fused segmental lordosis angle between the 2 groups; there was also no significant difference in clinical outcomes (NDI scores, VAS scores, Odom criteria) between the 2 groups. However, the intraoperative blood loss was significantly greater in the autograft group, and the operative time was also significantly longer in the autograft group (P < .001). In the autograft group, 6 patients (18.8%) had minor complications at the donor site.In 2-level ACDF with plate fixation, the radiologic and clinical outcomes of autograft and allograft were similar at 2-year follow-up, although fusion was observed earlier in the autograft group.
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Affiliation(s)
- Jin-Sung Park
- Department of Orthopedics, Spine Center, Samsung Medical Center, Sungkyunkwan, University, School of Medicine, Seoul
- Department of Orthopedics, Korea University Ansan Hospital, Korea University College of Medicine, Ansan-si, South Korea
| | - Se-Jun Park
- Department of Orthopedics, Spine Center, Samsung Medical Center, Sungkyunkwan, University, School of Medicine, Seoul
| | - Chong-Suh Lee
- Department of Orthopedics, Spine Center, Samsung Medical Center, Sungkyunkwan, University, School of Medicine, Seoul
| | - Sung-Soo Chung
- Department of Orthopedics, Spine Center, Samsung Medical Center, Sungkyunkwan, University, School of Medicine, Seoul
| | - Hyun-Jin Park
- Department of Orthopedics, Spine Center, Samsung Medical Center, Sungkyunkwan, University, School of Medicine, Seoul
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25
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Mokawem M, Katzouraki G, Harman CL, Lee R. Lumbar interbody fusion rates with 3D-printed lamellar titanium cages using a silicate-substituted calcium phosphate bone graft. J Clin Neurosci 2019; 68:134-139. [PMID: 31351704 DOI: 10.1016/j.jocn.2019.07.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 06/13/2019] [Accepted: 07/04/2019] [Indexed: 12/15/2022]
Abstract
The synthetic bone graft material, silicate-substituted calcium phosphate (SiCaP), has been successfully used in spinal fusion surgery. The efficacy of SiCaP-packed 3D-printed lamellar titanium cages used in transforaminal lumbar interbody fusion (TLIF) and lateral lumbar interbody fusion (LLIF) requires investigation. This study evaluated the efficacy of this combination in TLIF and LLIF surgeries treating adult spinal deformities and degenerative disorders. We retrospectively analysed a consecutive case series of 93 adult patients with lumbar degenerative disease or deformity requiring interbody cages who underwent TLIF or LLIF surgery with SiCaP-packed 3D-printed lamellar titanium cages, performed by a single lead surgeon. The primary endpoint was solid fusion 12 months after surgery, assessed using computed tomography. Secondary endpoints were patient-reported outcomes; EuroQOL five dimensions (EQ-5D), visual analogue scale (VAS) for pain (EQ-5D VAS), VAS pain scores for leg and back, and Oswestry disability index (ODI). Complications were recorded. Computed tomography revealed solid fusion in 92/93 (98.9%) patients with good cage integration at the vertebral body interface and no evidence of screw loosening. Patient-reported outcomes significantly improved for all parameters 1 year post-operation. Mean VAS significantly declined 1 year following TLIF surgery (back: -5.5; leg: -6.7) and following LLIF surgery (back: -5.9; leg: -6.9). Mean ODI declined 1 year following TLIF surgery (-43.0) from crippled to minimal disability and following LLIF surgery (-41.2) from severe to minimal disability. SiCaP-packed 3D-printed lamellar titanium cages provided excellent rates of solid fusion in TLIF and LLIF surgeries with notable improvements in patient-reported outcomes.
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Affiliation(s)
- Michael Mokawem
- Spinal Surgery Unit, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK.
| | - Galateia Katzouraki
- Spinal Surgery Unit, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK
| | - Clare L Harman
- Spinal Surgery Unit, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK
| | - Robert Lee
- Spinal Surgery Unit, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK
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Bolger C, Jones D, Czop S. Evaluation of an increased strut porosity silicate-substituted calcium phosphate, SiCaP EP, as a synthetic bone graft substitute in spinal fusion surgery: a prospective, open-label study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:1733-1742. [DOI: 10.1007/s00586-019-05926-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 01/30/2019] [Indexed: 10/27/2022]
Abstract
Abstract
Purpose
Silicate-substituted calcium phosphate-enhanced porosity (SiCaP EP, Inductigraft™, Altapore) is a synthetic bone graft material with enhanced strut porosity of 31–47%. SiCaP EP remains to be fully clinically evaluated in patients undergoing instrumented posterolateral fusion (PLF) surgery. We conducted a prospective, open-label, non-randomised, multicentre clinical study to evaluate efficacy of SiCaP EP as bone grafting material in PLF surgery with instrumentation for treatment of spinal disorders.
Methods
Patients with degenerative disc disease, spondylolisthesis or spinal stenosis underwent PLF surgery with SiCaP EP. The primary endpoint was evaluated in the per protocol population (N = 102) as solid fusion at postoperative month 12 assessed using computed tomography scans, with motion assessed using flexion–extension radiographs. Clinical outcomes included the Oswestry Disability Index, 36-item short-form health survey for quality-of-life, visual analog scale for pain scores and neurological assessments. Adverse events were recorded.
Results
Successful fusion was achieved in 59/89 (66.3%) patients at month 6, 88/102 patients (86.3%) at month 12 (primary endpoint) and 87/96 (90.6%) patients at month 24. Disability and pain reduced following surgery. Quality-of-life improved and neurological function was maintained postoperatively. Forty-three (33.3%) of the 129 patients who underwent surgery experienced adverse events; back pain was most frequent (n = 10); nine and 14 patients experienced serious adverse events judged related to device and procedure, respectively.
Conclusions
Enhanced strut porosity SiCaP EP provided high (month 12: 86.3%) spinal fusion success rates in PLF surgery. Fusion success was associated with improved clinical outcomes in patients within 12 months, relative to baseline.
ClinicalTrials.gov identifier
NCT01452022
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.
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28
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Lee D, Heo DN, Nah HR, Lee SJ, Ko WK, Lee JS, Moon HJ, Bang JB, Hwang YS, Reis RL, Kwon IK. Injectable hydrogel composite containing modified gold nanoparticles: implication in bone tissue regeneration. Int J Nanomedicine 2018; 13:7019-7031. [PMID: 30464456 PMCID: PMC6219106 DOI: 10.2147/ijn.s185715] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND For effective bone regeneration, it is necessary to implant a biocompatible scaffold that is capable of inducing cell growth and continuous osteogenic stimulation at the defected site. Here, we suggest an injectable hydrogel system using enzymatic cross-linkable gelatin (Gel) and functionalized gold nanoparticles (GNPs). METHODS In this work, tyramine (Ty) was synthesized on the gelatin backbone (Gel-Ty) to enable a phenol crosslinking reaction with horseradish peroxidase (HRP). N-acetyl cysteine (NAC) was attached to the GNPs surface (G-NAC) for promoting osteodifferentiation. RESULTS The Gel-Ty hydrogels containing G-NAC (Gel-Ty/G-NAC) had suitable mechanical strength and biocompatibility to embed and support the growth of human adipose derived stem cells (hASCs) during a proliferation test for three days. In addition, G-NAC promoted osteodifferentiation both when it was included in Gel-Ty and when it was used directly in hASCs. The osteogenic effects were demonstrated by the alkaline phosphatase (ALP) activity test. CONCLUSION These findings indicate that the phenol crosslinking reaction is suitable for injectable hydrogels for tissue regeneration and G-NAC stimulate bone regeneration. Based on our results, we suggest that Gel-Ty/G-NAC hydrogels can serve both as a biodegradable graft material for bone defect treatment and as a good template for tissue engineering applications such as drug delivery, cell delivery, and various tissue regeneration uses.
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Affiliation(s)
- Donghyun Lee
- Department of Dental Materials, School of Dentistry, Kyung Hee University, Seoul 02447, Republic of Korea,
| | - Dong Nyoung Heo
- Department of Engineering Science and Mechanics, Pennsylvania State University, Pennsylvania 16802, USA
| | - Ha Ram Nah
- Department of Detistry, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Sang Jin Lee
- Department of Dental Materials, School of Dentistry, Kyung Hee University, Seoul 02447, Republic of Korea,
| | - Wan-Kyu Ko
- Department of Neurosurgery, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do 13496, Republic of Korea
| | - Jae Seo Lee
- Department of Detistry, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Ho-Jin Moon
- Department of Dental Materials, School of Dentistry, Kyung Hee University, Seoul 02447, Republic of Korea,
| | - Jae Beum Bang
- Department of Dental Education, School of Dentistry, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Yu-Shik Hwang
- Department of Maxillofacial Biomedical Engineering, School of Dentistry, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Rui L Reis
- Department of Dental Materials, School of Dentistry, Kyung Hee University, Seoul 02447, Republic of Korea,
- The Discoveries Centre for Regenerative and Precision Medicine, Headquarters at University of Minho, Barco, Guimarães, Portugal
| | - Il Keun Kwon
- Department of Dental Materials, School of Dentistry, Kyung Hee University, Seoul 02447, Republic of Korea,
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Geale K, Álvarez M, Polyzoi M, Màlaga X, Pineda C, Hernández C. Budget impact analysis of demineralized bone matrix in combination with autograft in lumbar spinal fusion procedures for the treatment of lumbar degenerative disc disease in Spain. J Med Econ 2018; 21:977-982. [PMID: 29911913 DOI: 10.1080/13696998.2018.1489256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To estimate the budget impact (BI) of introducing local autograft (LA) combined with demineralized bone matrix (LA + DBM) in lumbar spinal fusion (LSF) procedures to treat lumbar degenerative disc disease (LDDD) in Spain. METHODS A decision tree model was developed to evaluate the 4-year BI associated with introducing LA + DBM putty to replace currently available grafting methods, including iliac crest bone graft (ICBG), LA alone, and LA combined with beta-tricalcium phosphate (LA + ceramics), with 30%, 40%, and 30% market shares, respectively. The analysis was conducted for a hypothetical cohort of 100 patients with LDDD receiving LSF, assuming LA + DBM would replace 100% of the standard of care mix. The fusion rates extracted from the literature were validated by an expert panel. Costs (€2017) were obtained from different Spanish sources. Budget impact and incremental cost per successful fusion were calculated from the perspective of the Spanish National Health System (NHS). RESULTS Over 4 years, replacing currently available options with LA + DBM for 100 patients resulted in an additional cost of €12,330 (€123/patient), and an additional 14 successful fusions, implying a cost of €881 per additional successful fusion. When costs of productivity loss were included, the introduction of LA + DBM resulted in cost savings of €70,294 (€703/patient). LIMITATIONS The lack of high-quality, homogeneous, head-to-head research studying the efficacy of grafting procedures available to patients undergoing LSF, in addition to a lack of long-term follow-up in existing studies. Therefore, the number of fusions occurring within the model's time horizon may be underestimated. CONCLUSIONS Acquisition costs of DBM were partially offset by costs of failed fusions, adverse events and reoperation when switching 100 hypothetical LDDD patients undergoing LSF procedures from standard of care grafting methods to LA + DBM from the perspective of the Spanish NHS. DBM cost was entirely offset when costs of lost productivity were considered.
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Affiliation(s)
- Kirk Geale
- a Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
- b PAREXEL International , Stockholm , Sweden
| | - María Álvarez
- c Health Economics and Outcomes Research, Medtronic Ibérica , Madrid , Spain
| | | | - Xavier Màlaga
- d Instituto Clavel de la Columna, Hospital Quirón Barcelona , Barcelona , Spain
| | - Cristina Pineda
- c Health Economics and Outcomes Research, Medtronic Ibérica , Madrid , Spain
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Guppy KH, Lee DJ, Harris J, Brara HS. Reoperation for Symptomatic Nonunions in Atlantoaxial (C1-C2) Fusions with and without Bone Morphogenetic Protein: A Cohort of 108 Patients with >2 Years Follow-Up. World Neurosurg 2018; 121:e458-e466. [PMID: 30267948 DOI: 10.1016/j.wneu.2018.09.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 09/17/2018] [Accepted: 09/18/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine if there is a difference in reoperation rates for symptomatic nonunions in atlantoaxial (C1-C2) fusions with or without bone morphogenetic protein (BMP) using data from a national spine registry and to analyze the different types of bone grafts used in the non-BMP group. METHODS Data from the Kaiser Permanente spine registry were used to identify patients with C1-C2 fusions with >2 years follow-up. Patient characteristics, diagnosis, operative times, length of stay, and reoperations were extracted from the registry. The data set was divided into patients with and without BMP. Further analysis was made of the different types of non-BMP grafts as well as the instrumentation used. RESULTS In our cohort, we found 58 patients (53.7%) with BMP and 50 patients (46.3%) without with an average follow-up time of 5 years (interquartile range, 2.04-8.49). The BMP versus non-BMP groups differed in admitting diagnosis, operative times, length of stay, and follow-up times. There were no reoperations for symptomatic nonunions in both groups. The non-BMP group included iliac crest graft (with or without allograft [+/-] allograft); lamina (+/- allograft); and allograft alone. CONCLUSIONS Using one of the largest retrospective studies on C1-C2 fusions with and without BMP, we found no difference in reoperation rates for symptomatic nonunions. For the non-BMP group, we found that lamina (+/- allograft) or allograft alone may also be just as effective as iliac crest graft (+/- allograft) in having no reoperations for symptomatic nonunions.
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Affiliation(s)
- Kern H Guppy
- Department of Neurosurgery, Kaiser Permanente Medical Group, Sacramento, California, USA.
| | - Darrin J Lee
- Department of Neurological Surgery, University of California, Davis, Sacramento, California, USA
| | - Jessica Harris
- Surgical Outcomes & Analysis Unit of Clinical Analysis, Kaiser Permanente, San Diego, California, USA
| | - Harsimran S Brara
- Department of Neurosurgery, Kaiser Permanente Southern California, Los Angeles, California, USA
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Biodegradable and biocompatible high elastic chitosan scaffold is cell-friendly both in vitro and in vivo. Oncotarget 2018; 8:35583-35591. [PMID: 28103580 PMCID: PMC5482600 DOI: 10.18632/oncotarget.14709] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 12/05/2016] [Indexed: 01/16/2023] Open
Abstract
Biodegradable and biocompatible macromolecule chitosan has been favored for a variety of clinical applications. We reported herein the fabrication of a novel chitosan scaffold with high elasticity. This scaffold can be easily compressed and thus enable the insertion of such scaffold into surgical lesions during minimal invasive surgeries. In addition, this novel scaffold can restore its shape when released. We evidenced that this high elastic scaffold has better biocompatibility than traditional chitosan scaffold. Therefore, this new chitosan material might lead to the manufacture of a variety of novel biodegradable biomedical materials and devices.
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32
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Sielatycki JA, Saito M, Yuasa M, Moore‐Lotridge SN, Uppuganti S, Colazo JM, Hysong AA, Robinette JP, Okawa A, Yoshii T, Schwartz HS, Nyman JS, Schoenecker JG. Autologous chondrocyte grafting promotes bone formation in the posterolateral spine. JOR Spine 2018; 1:e1001. [PMID: 31463433 PMCID: PMC6686810 DOI: 10.1002/jsp2.1001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 01/23/2018] [Accepted: 01/25/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND CONTEXT Pseudarthrosis following spinal fusion remains problematic despite modern surgical and grafting techniques. In surgical spinal fusion, new bone forms via intramembranous and endochondral ossification, with endochondral ossification occurring in the hypoxic zones of the fusion bed. During bone development and fracture healing, the key cellular mediator of endochondral ossification is the hypertrophic chondrocyte given its ability to function in hypoxia and induce neovascularization and ossification. We therefore hypothesize that hypertrophic chondrocytes may be an effective bone graft alternative. PURPOSE Spinal fusion procedures have increased substantially; yet 5% to 35% of all spinal fusions may result in pseudoarthrosis. Pseudoarthrosis may occur because of implant failure, infection, or biological failure, among other reasons. Advances in surgical techniques and bone grafting have improved fusion; however pseudarthrosis rates remain unacceptably high. Thus, the goal of this study is to investigate hypertrophic chondrocytes as a potential biological graft alternative. METHODS Using a validated murine fracture model, hypertrophic chondrocytes were harvested from fracture calluses and transplanted into the posterolateral spines of identical mice. New bone formation was assessed by X-ray, microcomputed tomography (μCT), and in vivo fluorescent imaging. Results were compared against a standard iliac crest bone graft and a sham surgery control group. Funding for this work was provided by the Department of Orthopaedics and Rehabilitation, the OREF (Grant #16-150), and The Caitlin Lovejoy Fund. RESULTS Radiography, μCT, and in vivo fluorescent imaging demonstrated that hypertrophic chondrocytes promoted bone formation at rates equivalent to iliac crest autograft. Additionally, μCT analysis demonstrated similar fusion rates in a subset of mice from the iliac crest and hypertrophic chondrocyte groups. CONCLUSIONS This proof-of-concept study indicates that hypertrophic chondrocytes can promote bone formation comparable to iliac crest bone graft. These findings provide the foundation for future studies to investigate the potential therapeutic use of hypertrophic chondrocytes in spinal fusion.
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Affiliation(s)
- J. Alex Sielatycki
- Department of Orthopaedics and RehabilitationVanderbilt University Medical CenterNashvilleTennessee
| | - Masanori Saito
- Department of Orthopaedics and RehabilitationVanderbilt University Medical CenterNashvilleTennessee
- Department of Orthopaedic SurgeryTokyo Medical and Dental UniversityTokyoJapan
| | - Masato Yuasa
- Department of Orthopaedics and RehabilitationVanderbilt University Medical CenterNashvilleTennessee
- Department of Orthopaedic SurgeryTokyo Medical and Dental UniversityTokyoJapan
| | - Stephanie N. Moore‐Lotridge
- Department of Orthopaedics and RehabilitationVanderbilt University Medical CenterNashvilleTennessee
- Department of PharmacologyVanderbilt UniversityNashvilleTennessee
| | - Sasidhar Uppuganti
- Department of Orthopaedics and RehabilitationVanderbilt University Medical CenterNashvilleTennessee
| | - Juan M. Colazo
- Vanderbilt University School of MedicineNashvilleTennessee
| | | | | | - Atsushi Okawa
- Department of Orthopaedic SurgeryTokyo Medical and Dental UniversityTokyoJapan
| | - Toshitaka Yoshii
- Department of Orthopaedic SurgeryTokyo Medical and Dental UniversityTokyoJapan
| | - Herbert S. Schwartz
- Department of Orthopaedics and RehabilitationVanderbilt University Medical CenterNashvilleTennessee
| | - Jeffry S. Nyman
- Department of Orthopaedics and RehabilitationVanderbilt University Medical CenterNashvilleTennessee
- Department of Biomedical EngineeringVanderbilt UniversityNashvilleTennessee
- Center for Bone BiologyVanderbilt University Medical CenterNashvilleTennessee
- Department of Veterans AffairsTennessee Valley Health Care SystemNashvilleTennessee
| | - Jonathan G. Schoenecker
- Department of Orthopaedics and RehabilitationVanderbilt University Medical CenterNashvilleTennessee
- Department of PharmacologyVanderbilt UniversityNashvilleTennessee
- Department of Pathology, Microbiology, and ImmunologyVanderbilt University Medical CenterNashvilleTennessee
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennessee
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Osteogenesis induced by a three-dimensional bioimplant composed of demineralised bone matrix, collagen, hydroxyapatite, and bone marrow-derived cells in massive bone defects: An experimental study. Tissue Cell 2017; 50:69-78. [PMID: 29429520 DOI: 10.1016/j.tice.2017.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 12/07/2017] [Accepted: 12/09/2017] [Indexed: 01/11/2023]
Abstract
Treatment of massive bone defects is one of the most difficult problems to solve in orthopedics. At present, there is no consensus on the best way to resolve these problems. The aim of our study was to evaluate the effect of a three-dimensional bioimplant over massive bone defects, and to analyse if it improves the speed and quality of integration in recipient bone compared to allograft treatment. Fifteen female lambs with massive bone defects, surgically created in their tibias, were randomly divided into three groups of five lambs each: Group I -treated with the bioimplant; Group 2 -treated with the bioimplant plus nucleated cells of autologous bone marrow; Group 3 -treated with a frozen allograft. Radiographs were taken post-treatment at weeks 1, 6, and 12. Animals were euthanized to obtain the studied bone segment for morphological analyses. TREATMENT with bioimplants vs. bioimplant plus bone marrow nucleated cells (BMNCs) showed a notorious osteogenic effect, but with greater osteoid synthesis and cellularity in the latter. These results suggest that combined treatment with bioimplants and BMNCs have an additive effect on massive bone defects in lambs. These experimental results could be applied to repair damaged human bone.
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Kim BJ, Arai Y, Park EM, Park S, Bello A, Han IB, Lee SH. Osteogenic Potential of Tauroursodeoxycholic Acid as an Alternative to rhBMP-2 in a Mouse Spinal Fusion Model. Tissue Eng Part A 2017; 24:407-417. [PMID: 28826347 DOI: 10.1089/ten.tea.2016.0349] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The non-union rate after lumbar spinal fusion is potentially as high as 48%. To support efficient bone regeneration, recombinant human bone morphogenetic protein-2 (rhBMP-2) is commonly used as it is regarded as the most potent bone-inducing molecule. However, recently, there have been increasing concerns on the use of rhBMP-2 such as serious complications, including seroma and heterotopic ossification, and the low quality of bone at the center of fusion mass. Thus, many studies were conducted to find and to develop a potential alternative to rhBMP-2. In this study, we investigated the osteogenic potential of tauroursodeoxycholic acid (TUDCA) in the mouse fusion model and compared its effects with rhBMP-2. Twenty-four mice underwent bilateral posterolateral lumbar spinal fusion bone formation at L4-L5. Collagen sponge infused with saline, TUDCA, or rhBMP-2 was implanted at the fusion area. Two and 4 weeks postimplantation, bone formation and tissue regeneration were evaluated via micro-computed tomography and histological analysis. Compared with the TUDCA-treated group, the rhBMP-2 treatment produced a higher amount of bone fusion formation after 2 weeks but also showed higher resorption of the centralized bone after 4 weeks. Interestingly, the TUDCA-treated group developed higher trabecular thickness compared with rhBMP-2 after 4 weeks. Moreover, TUDCA treatment showed distinct angiogenic activity in human umbilical vein endothelial cells as confirmed by an in vitro tube formation assay. Our findings suggest that TUDCA is comparable to rhBMP-2 in supporting bone regeneration and spinal bone formation fusion by increasing trabecular thickness and promoting angiogenesis. Finally, our results indicate that TUDCA can be utilized as a potential alternative to rhBMP-2.
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Affiliation(s)
- Byoung Ju Kim
- 1 Department of Biomedical Science, College of Life Science, CHA University , Seongnam-si, Korea
| | - Yoshie Arai
- 1 Department of Biomedical Science, College of Life Science, CHA University , Seongnam-si, Korea
| | - Eun-Mi Park
- 1 Department of Biomedical Science, College of Life Science, CHA University , Seongnam-si, Korea
| | - Sunghyun Park
- 1 Department of Biomedical Science, College of Life Science, CHA University , Seongnam-si, Korea
| | - Alvin Bello
- 1 Department of Biomedical Science, College of Life Science, CHA University , Seongnam-si, Korea
| | - In-Bo Han
- 1 Department of Biomedical Science, College of Life Science, CHA University , Seongnam-si, Korea.,2 Department of Neurosurgery, CHA Bundang Medical Center, CHA University , Seongnam-si, Korea
| | - Soo-Hong Lee
- 1 Department of Biomedical Science, College of Life Science, CHA University , Seongnam-si, Korea
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Yang HS, Kim KW, Oh YM, Eun JP. Usefulness of titanium mesh cage for posterior C1-C2 fixation in patients with atlantoaxial instability. Medicine (Baltimore) 2017; 96:e8022. [PMID: 28885370 PMCID: PMC6392941 DOI: 10.1097/md.0000000000008022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to investigate the usefulness of titanium mesh cage as an interlaminar spacer combined with nitinol shape memory loop fixation in patients with atlantoaxial instability.From April 2009 to March 2017, among the patients with atlantoaxial instability, a total of 30 patients were treated by nitinol shape memory loop fixation combined with titanium mesh cage as a spacer. We retrospectively reviewed 30 enrolled patients. Successful fusion was determined as improvement of symptoms and radiologic findings of bone fusion. We also reviewed surgical complications, instrumentation failure, bony fusion rate, and posterior atlantodental interval (PADI).After surgery, the symptoms of all patients significantly improved. Successful fusion was documented throughout the follow-up period. Evidence of solid bridging bone was found, and no instability was seen on flexion-extension radiographs and callus formation on 3D cervical spine computed tomography (CT) 6 months postoperatively in all cases. No surgical complications were observed. No cases of instrumentation failure were observed. The mean PADI also improved significantly to 22.45 ± 1.11 mm 6 months postoperatively compared with the preoperative value of 18.37 ± 1.16 mm (P < .05).We obtained a good fusion rate by using titanium mesh cage spacer with nitinol shape memory alloy loop in patients with atlantoaxial instability. This technique can help surgeons in avoiding vertebral artery injury and reducing bleeding and operation time. Therefore, we suggest that titanium mesh cage spacer combined with nitinol shape memory alloy loop can be a good substitute of autograft for C1-C2 fusion in treating atlantoaxial instabilities.
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Le Pape S, Gauthe R, Du Pouget L, Gille O, Vital JM, Ould-Slimane M. Endopelvic Approach for Iliac Crest Bone Harvesting. World Neurosurg 2017; 106:764-767. [PMID: 28739516 DOI: 10.1016/j.wneu.2017.07.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 07/14/2017] [Accepted: 07/15/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND The anterior approach to lumbar spine surgery has grown in popularity in the past few years; spinal fusion of the last 2 lumbar levels is often required. Although alternatives to bone grafting are available, including recombinant human bone morphogenetic protein 2 or bone substitutes, only cancellous autologous bone has all the required factors for bone growth. To avoid the use of bone substitutes, remote iliac crest bone harvesting remains the gold standard. However, this technique may lead to some unfavorable outcomes. CASE DESCRIPTION The patient was a 46-year-old man with severe back and left leg pain. Magnetic resonance imaging showed an inflammatory discopathy of L5-S1 associated with a left posterior lateral herniated disc. Conservative treatment failed, and surgical treatment of the lumbar disk disease and the herniated disc was scheduled. A novel iliac crest bone harvesting method was performed during the retroperitoneal approach to the anterior lumbar interbody fusion. The patient's postoperative course was uneventful. There were no adverse outcomes related to the bone donor site. CONCLUSIONS This is the first in vivo report of endopelvic iliac crest bone harvesting. This technique allows bone graft harvesting to be performed with the same retroperitoneal approach used for anterior lumbar interbody fusion. It avoids many common complications associated with the remote approach to the iliac crest.
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Affiliation(s)
- Sebastien Le Pape
- Regional Spine Institute, University Hospital of Rouen, Rouen, France.
| | - Remi Gauthe
- Regional Spine Institute, University Hospital of Rouen, Rouen, France
| | - Laure Du Pouget
- Department of Urology, University Hospital of Rouen, Rouen, France
| | - Olivier Gille
- Spine Unit 1, University Hospital Pellegrin, Bordeaux, France
| | - Jean-Marc Vital
- Spine Unit 1, University Hospital Pellegrin, Bordeaux, France
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Cross-Sectional Area of the Lumbar Spine Trunk Muscle and Posterior Lumbar Interbody Fusion Rate: A Retrospective Study. Clin Spine Surg 2017; 30:E798-E803. [PMID: 27623301 DOI: 10.1097/bsd.0000000000000424] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE To investigate the relationship between trunk muscle cross-sectional area (MCSA) and fusion rate after posterior lumbar interbody fusion using pedicle screw fixation (PLIF-PSF). SUMMARY OF BACKGROUND DATA Although trunk muscles of the lumbar spine contribute to spinal stability and alignment, effect of trunk muscles on spinal fusion rate and time to fusion is unclear. METHODS A total of 192 adult patients with degenerative lumbar disease who underwent PLIF-PSF at L3-L4 or L4-L5 were included. The MCSA of the flexor (psoas major, PS), extensor (erector spinae, ES; multifidus, MF) were measured using preoperative lumbar magnetic resonance imaging at 3 segments. Bone union was evaluated using lumbar dynamic plain radiography. Patients were divided into 2 groups according to the presence of bone fusion. RESULTS Most PS MCSAs in the fusion group were significantly larger than in the nonfusion group, except for MCSA at the L2-L3 segment (all P<0.05). In cases of ES and MF MCSAs, 4 of 6 segments were significantly large. Multivariate analysis revealed that the PS MCSA at L4-L5 was an independent factor for decreased possibility of nonfusion status in both segments (OR=0.812, P=0.028). Pearson analysis demonstrated that the most trunk MCSAs were negatively correlated with time to fusion for both segments and PS MCSAs exhibited a significant correlation with time to fusion except for MCSA at the L2-L3 segment. CONCLUSIONS Trunk MCSAs were significantly larger for a fusion group than a nonfusion group. As trunk MCSAs increased, fusion timing decreased.
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Zhang YH, Shen L, Shao J, Chou D, Song J, Zhang J. Structural Allograft versus Autograft for Instrumented Atlantoaxial Fusions in Pediatric Patients: Radiologic and Clinical Outcomes in Series of 32 Patients. World Neurosurg 2017. [PMID: 28624564 DOI: 10.1016/j.wneu.2017.06.048] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Allograft with wire techniques showed a low fusion rate in pediatric atlantoaxial fusions (AAFs) in early studies. Using allograft in pediatric AAFs with screw/rod constructs has not been reported. Thus we compared the fusion rate and clinical outcomes in pediatric patients who underwent AAFs with screw/rod constructs using either a structural autograft or allograft. METHODS Pediatric patients (aged ≤12 years) who underwent AAFs between 2007 and 2015 were retrospectively evaluated. Patients were divided into 2 groups (allograft or autograft). Clinical and radiographic results were collected from hospital records and compared. RESULTS A total of 32 patients were included (18 allograft, 14 autograft). There were no significant group differences in age, sex, weight, diagnosis, or duration of follow-up. A similar fusion rate was achieved (allograft: 94%, 17/18; autograft: 100%, 14/14); however, the average fusion time was 3 months longer in the allograft group. Blood loss was significantly lower in the allograft group (68 ± 8.5 mL) than the autograft group (116 ± 12.5 mL). Operating time and length of hospitalization were slightly (nonsignificantly) shorter for the allograft group. A significantly higher overall incidence of surgery-related complications was seen in the autograft group, including a 16.7% (2/14) rate of donor-site-related complications. CONCLUSIONS The use of allograft for AAF was safe and efficacious when combined with rigid screw/rod constructs in pediatric patients, with a similar fusion rate to autografts and an acceptable complication rate. Furthermore, blood loss was less when using allograft and donor-site morbidity was eliminated; however, the fusion time was increased.
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Affiliation(s)
- Yue-Hui Zhang
- Department of Orthopedic Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Shen
- Department of Orthopedic Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiang Shao
- Department of Orthopedic Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Dean Chou
- Department of Neurosurgery, University of California, San Francisco, California, USA
| | - Jia Song
- Department of Orthopedic Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Zhang
- Department of Orthopedic Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Aquino-Martínez R, Artigas N, Gámez B, Rosa JL, Ventura F. Extracellular calcium promotes bone formation from bone marrow mesenchymal stem cells by amplifying the effects of BMP-2 on SMAD signalling. PLoS One 2017; 12:e0178158. [PMID: 28542453 PMCID: PMC5444778 DOI: 10.1371/journal.pone.0178158] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 05/09/2017] [Indexed: 11/23/2022] Open
Abstract
Understanding the molecular events that regulate osteoblast differentiation is essential for the development of effective approaches to bone regeneration. In this study, we analysed the osteoinductive properties of extracellular calcium in bone marrow-derived mesenchymal stem cell (BM-MSC) differentiation. We cultured BM-MSCs in 3D gelatin scaffolds with Ca2+ and BMP-2 as osteoinductive agents. Early and late osteogenic gene expression and bone regeneration in a calvarial critical-size defect model demonstrate that extracellular Ca2+ enhances the effects of BMP-2 on Osteocalcin, Runx2 and Osterix expression and promotes bone regeneration in vivo. Moreover, we analysed the molecular mechanisms involved and observed an antagonistic effect between Ca2+ and BMP-2 on SMAD1/5, ERK and S6K signalling after 24 hours. More importantly, a cooperative effect between Ca2+ and BMP-2 on the phosphorylation of SMAD1/5, S6, GSK3 and total levels of β-CATENIN was observed at a later differentiation time (10 days). Furthermore, Ca2+ alone favoured the phosphorylation of SMAD1, which correlates with the induction of Bmp2 and Bmp4 gene expression. These data suggest that Ca2+ and BMP-2 cooperate and promote an autocrine/paracrine osteogenic feed-forward loop. On the whole, these results demonstrate the usefulness of calcium-based bone grafts or the addition of exogenous Ca2+ in bone tissue engineering.
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Affiliation(s)
- Rubén Aquino-Martínez
- Departament de Ciències Fisiològiques, Universitat de Barcelona, IDIBELL, L’Hospitalet de Llobregat, Spain
| | - Natalia Artigas
- Departament de Ciències Fisiològiques, Universitat de Barcelona, IDIBELL, L’Hospitalet de Llobregat, Spain
| | - Beatriz Gámez
- Departament de Ciències Fisiològiques, Universitat de Barcelona, IDIBELL, L’Hospitalet de Llobregat, Spain
| | - José Luis Rosa
- Departament de Ciències Fisiològiques, Universitat de Barcelona, IDIBELL, L’Hospitalet de Llobregat, Spain
| | - Francesc Ventura
- Departament de Ciències Fisiològiques, Universitat de Barcelona, IDIBELL, L’Hospitalet de Llobregat, Spain
- * E-mail:
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Abstract
STUDY DESIGN This is a retrospective study analysis. OBJECTIVE The purpose of our study was to evaluate the healing process of the ilium after being used as a bone graft donor site in the treatment of adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA Iliac crest bone grafts have been proven to be the most reliable means for solid fusion in spine surgery. Nevertheless, few reports in the literature describe the ability of the iliac crest to regenerate. METHODS Thirty-one patients with a mean age of 15.1 years had undergone posterior spinal fusion for idiopathic scoliosis. An autogenous bone graft was harvested from the right posterior iliac crest in all cases. Computed tomography scans of the pelvis were performed preoperatively and shortly after operation to evaluate the presence of any deformity and the size of the defect formed during surgery, respectively. All patients were reexamined 14 years postoperatively, and computed tomography scans were performed to evaluate the status of ossification at the donor site. RESULTS In 21 cases (67.74%), bone deficits were fully restored (mean volume 12.053 cm), whereas partial regeneration was present in the remaining 10 cases (mean volume 8.766 cm). Hounsfield units (HUs) revealed that cancellous bone quality had been restored in 21 cases, whereas cysts with sclerotic bone margins were present in the remaining 10 cases. Immature patients [Risser sign (RS) 3, 4] have greater ability in restoring bone stock compared with patients with almost complete growth (RS 5; P<0.001). In addition, the gluteus maximus muscle preserved its volume and quality in cases with complete bone restoration (volume 51.3 cm, HU 55.9) compared with cases with partial regeneration (volume 43.43 cm, HU 38.35; P<0.001). CONCLUSIONS The iliac wing of skeletally immature patients has considerable ability to fully regenerate and could probably be used as a graft donor site again.
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Bone Union Rate Following Instrumented Posterolateral Lumbar Fusion: Comparison between Demineralized Bone Matrix versus Hydroxyapatite. Asian Spine J 2016; 10:1149-1156. [PMID: 27994793 PMCID: PMC5165007 DOI: 10.4184/asj.2016.10.6.1149] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 04/13/2016] [Accepted: 04/27/2016] [Indexed: 11/08/2022] Open
Abstract
Study Design Retrospective study. Purpose To compare the union rate of posterolateral lumbar fusion (PLF) using demineralized bone matrix (DBM) versus hydroxyapatite (HA) as bone graft extender. Overview of Literature To our knowledge, there has been no clinical trial to compare the outcomes of DBM versus HA as a graft material for PLF. Methods We analyzed prospectively collected data from consecutive 79 patients who underwent instrumented PLF. Patients who received DBM were assigned to group B (n=38), and patients who received HA were assigned into group C (n=41). The primary study outcome was fusion rate assessed with radiographs. The secondary outcomes included pain intensity using a visual analogue scale, functional outcome using Oswestry disability index score, laboratory tests of inflammatory profiles and infection rate. Results One year postoperatively, bone fusion was achieved in 73% in group B and 58% in group C without significant difference between the groups (p=0.15). There were no differences between the groups with respect to secondary outcomes. Conclusions DBM would provide noninferior outcomes compared to the HA as a fusion material for PLF, and could be a notable alternative.
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Retrospective Study of Anterior Interbody Fusion Rates and Patient Outcomes of Using Mineralized Collagen and Bone Marrow Aspirate in Multilevel Adult Spinal Deformity Surgery. Clin Spine Surg 2016; 29:E384-8. [PMID: 27171663 DOI: 10.1097/bsd.0b013e318292468f] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
DESIGN Retrospective, single-center analysis of multilevel anterior fusion rates and health-related quality-of-life outcomes of mineralized collagen and bone marrow aspirate (BMA) in anterior interbody fusion cages for spine fusion surgery. OBJECTIVE To determine the ability and effectiveness of mineralized collagen and BMA to achieve multilevel anterior spinal fusion in adult spinal deformity patients when placed in carbon fiber reinforced polymer cages. SUMMARY OF BACKGROUND DATA High rates of postoperative pain and nonunion can result from spine fusion procedures. Factors that affect the success of fusion include patient comorbidities, position of implant, and mechanical and biological deficiencies, as well as the choice of bone graft replacement. METHODS Analysis of radiographic images and health-related quality-of-life outcomes was performed for a consecutive series of 22 prospectively enrolled adult spinal deformity patients with 104 total anterior fusion levels. Fusions were graded by 3 blinded surgeons not involved in the operative procedure; each fusion was graded on a 1-4 scale based on fusion mass appearance. Levels with an average fusion grade of 1-2.4 were classified as fused; levels with an average grade >2.5 were classified as not fused. RESULTS The mean patient age was 51.5 years (range, 38-61) with 21 females. A total of 95% of anterior operative levels were graded as fused based on flexion/extension and full-length biplane radiographs at 1 year. Computed tomography grading showed a reduced fusion rate at 87% overall. There was a statistically significant improvement in the Oswestry Disability Index and Scoliosis Research Society 22-item questionnaire scores at 1 and 2 years after index surgery. CONCLUSIONS Fusion rates in multilevel anterior spinal fusion using mineralized collagen and BMA are relatively low compared with fusion rates of 95% or more reported in the existing literature on long fusions with bone morphogenetic protein.
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Tuchman A, Brodke DS, Youssef JA, Meisel HJ, Dettori JR, Park JB, Yoon ST, Wang JC. Iliac Crest Bone Graft versus Local Autograft or Allograft for Lumbar Spinal Fusion: A Systematic Review. Global Spine J 2016; 6:592-606. [PMID: 27556001 PMCID: PMC4993607 DOI: 10.1055/s-0035-1570749] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 11/17/2015] [Indexed: 01/08/2023] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVE To compare the effectiveness and safety between iliac crest bone graft (ICBG) and local autologous bone and allograft in the lumbar spine. METHODS A systematic search of multiple major medical reference databases identified studies evaluating spinal fusion in patients with degenerative joint disease using ICBG, local autograft, or allograft in the thoracolumbar spine. RESULTS Six comparative studies met our inclusion criteria. A "low" strength of the overall body of evidence suggested no difference in fusion percentages in the lumbar spine between local autograft and ICBG. We found no difference in fusion percentages based on low evidence comparing allograft with ICBG autograft. There were no differences in pain or functional results comparing local autograft or allograft with ICBG autograft. Donor site pain and hematoma/seroma occurred more frequently in ICBG autograft group for lumbar fusion procedures. There was low evidence around the estimate of patients with donor site pain following ICBG harvesting, ranging from 16.7 to 20%. With respect to revision, low evidence demonstrated no difference between allograft and ICBG autograft. There was no evidence comparing patients receiving allograft with local autograft for fusion, pain, functional, and safety outcomes. CONCLUSION In the lumbar spine, ICBG, local autograft, and allograft have similar effectiveness in terms of fusion rates, pain scores, and functional outcomes. However, ICBG is associated with an increased risk for donor site-related complications. Significant limitations exist in the available literature when comparing ICBG, local autograft, and allograft for lumbar fusion, and thus ICBG versus other fusion methods necessitates further investigation.
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Affiliation(s)
- Alexander Tuchman
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States,Address for correspondence Alexander Tuchman, MD Department of Neurological Surgery, Keck School of MedicineUniversity of Southern California1200 N. State Street, Suite 3300, Los Angeles, CA 90033United States
| | - Darrel S. Brodke
- Department of Orthopedics, University of Utah, School of Medicine, Salt Lake City, Utah, United States
| | - Jim A. Youssef
- Durango Orthopedic Associates, P.C./Spine Colorado, Durango, Colorado, United States
| | - Hans-Jörg Meisel
- Department of Neurosurgery, Bergmannstrost Hospital, Halle, Germany
| | | | - Jong-Beom Park
- Department of Orthopaedic Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea School of Medicine, Uijeongbu, Korea
| | - S. Tim Yoon
- Department of Orthopedics, Emory Spine Center, Atlanta, Georgia, United States
| | - Jeffrey C. Wang
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
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Guppy KH, Harris J, Chen J, Paxton EW, Bernbeck JA. Reoperation rates for symptomatic nonunions in posterior cervicothoracic fusions with and without bone morphogenetic protein in a cohort of 450 patients. J Neurosurg Spine 2016; 25:309-17. [DOI: 10.3171/2016.1.spine151330] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Fusions across the cervicothoracic junction have been challenging because of the large biomechanical forces exerted resulting in frequent reoperations for nonunions. The objective of this study was to investigate a retrospective cohort using chart review of posterior cervicothoracic spine fusions with and without bone morphogenetic protein (BMP) and to determine the reoperation rates for symptomatic nonunions in both groups.
METHODS
Between January 2009 and September 2013, posterior cervicothoracic spine fusion cases were identified from a large spine registry (Kaiser Permanente). Demographics, diagnoses, operative times, lengths of stay, and reoperations were extracted from the registry. Reoperations for symptomatic nonunions were adjudicated via chart review. Logistic regression was used to estimate odds ratios and 95% confidence intervals. Kaplan-Meier curves for the non-BMP and BMP groups were generated and compared using the log-rank test.
RESULTS
In this cohort there were 450 patients (32.7% with BMP) with a median follow-up of 1.4 years (interquartile range [IQR] 0.5–2.7 years). Kaplan-Meier curves showed no significant difference in reoperation rates for nonunions using the log-rank test (p = 0.088). In a subset of patients with more than 1 year of follow-up, 260 patients were identified (43.1% with BMP) with a median follow-up duration of 2.4 years (IQR 1.6–3.3 years). There was no statistically significant difference in the symptomatic operative nonunion rates for posterior cervicothoracic fusions with and without BMP (0.0% vs 2.7%, respectively; p = 0.137) for more than 1 year of follow-up.
CONCLUSIONS
This study presents the largest series of patients using BMP in posterior cervicothoracic spine fusions. Reoperation rates for symptomatic nonunions with more than 1 year of follow-up were 0% with BMP and 2.7% without BMP. No statistically significant difference in the reoperation rates for symptomatic nonunions with or without BMP was found.
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Affiliation(s)
- Kern H. Guppy
- 1Department of Neurosurgery, Kaiser Permanente Medical Group, Sacramento
| | - Jessica Harris
- 2Surgical Outcomes & Analysis Unit of Clinical Analysis, Kaiser Permanente, San Diego; and
| | - Jason Chen
- 2Surgical Outcomes & Analysis Unit of Clinical Analysis, Kaiser Permanente, San Diego; and
| | - Elizabeth W. Paxton
- 2Surgical Outcomes & Analysis Unit of Clinical Analysis, Kaiser Permanente, San Diego; and
| | - Johannes A. Bernbeck
- 3Department of Orthopaedics, Kaiser Permanente Southern California, Baldwin Park, California
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Appropriate and Effective Dosage of BMP-2 for the Ideal Regeneration of Calvarial Bone Defects in Beagles. Plast Reconstr Surg 2016; 138:64e-72e. [DOI: 10.1097/prs.0000000000002290] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Evaluation of the Efficacy of Titanium Mesh Cages with Posterior C1 Lateral Mass and C2 Pedicle Screw Fixation in Patients with Atlantoaxial Instability. World Neurosurg 2016; 90:103-108. [DOI: 10.1016/j.wneu.2016.02.087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/18/2016] [Accepted: 02/19/2016] [Indexed: 11/21/2022]
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Anatomic feasibility of a new endopelvic approach for iliac crest bone harvesting. Surg Radiol Anat 2016; 38:1191-1194. [PMID: 27160584 DOI: 10.1007/s00276-016-1686-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 04/29/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE For the past few years, anterior exposure for surgery of the lumbar spine has gained popularity for the treatment of disk disease or spondylosis. Cancellous bone remains the gold standard for fusion. Iliac crest bone harvesting is safe but there are donor site complications. Bone substitutes exist, like recombinant human bone morphogenic protein-2 rhBMP-2. This alternative offers a high rate of fusion but with local and general complications. The aim of our study is to show the feasibility of an endopelvic approach for iliac bone crest harvesting to avoid donor site complication. METHOD Twenty anterior retroperitoneal lumbar spine approaches have been realized in the anatomy department of the University of Bordeaux. The volumes of cancellous bone have been measured and procedure complications have been reported. RESULTS The mean volume of cancellous bone was 5.9 cc, the maximum volume was 8.2 cc and the minimum volume was 4.5 cc. No complications have been reported during the approach or the bone harvesting. CONCLUSIONS Anterior retroperitoneal approach for iliac bone crest harvesting is a safe way to obtain sufficient volume of cancellous bone for a single lumbar spinal fusion. This exposure avoids the risks of an iliac crest donor site complications or rhBMP-2 complications.
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Evaluation of Anterior Vertebral Interbody Fusion Using Osteogenic Mesenchymal Stem Cells Transplanted in Collagen Sponge. Clin Spine Surg 2016; 29:E201-7. [PMID: 22576723 DOI: 10.1097/bsd.0b013e31825ca123] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
STUDY DESIGN The study used a rabbit model to achieve anterior vertebral interbody fusion using osteogenic mesenchymal stem cells (OMSCs) transplanted in collagen sponge. OBJECTIVE We investigated the effectiveness of graft material for anterior vertebral interbody fusion using a rabbit model by examining the OMSCs transplanted in collagen sponge. SUMMARY OF BACKGROUND DATA Anterior vertebral interbody fusion is commonly performed. Although autogenous bone graft remains the gold-standard fusion material, it requires a separate surgical procedure and is associated with significant short-term and long-term morbidity. Recently, mesenchymal stem cells from bone marrow have been studied in various fields, including posterolateral spinal fusion. Thus, we hypothesized that cultured OMSCs transplanted in porous collagen sponge could be used successfully even in anterior vertebral interbody fusion. METHODS Forty mature male White Zealand rabbits (weight, 3.5-4.5 kg) were randomly allocated to receive one of the following graft materials: porous collagen sponge plus cultured OMSCs (group I); porous collagen sponge alone (group II); autogenous bone graft (group III); and nothing (group IV). All animals underwent anterior vertebral interbody fusion at the L4/L5 level. The lumbar spine was harvested en bloc, and the new bone formation and spinal fusion was evaluated using radiographic analysis, microcomputed tomography, manual palpation test, and histologic examination at 8 and 12 weeks after surgery. RESULTS New bone formation and bony fusion was evident as early as 8 weeks in groups I and III. And there was no statistically significant difference between 8 and 12 weeks. At both time points, by microcomputed tomography and histologic analysis, new bone formation was observed in both groups I and III, fibrous tissue was observed and there was no new bone in both groups II and IV; by manual palpation test, bony fusion was observed in 40% (4/10) of rabbits in group I, 70% (7/10) of rabbits in group III, and 0% (0/10) of rabbits in both groups II and IV. CONCLUSIONS These findings suggest that mesenchymal stem cells that have been cultured with osteogenic differentiation medium and loaded with collagen sponge could induce bone formation and anterior vertebral interbody fusion. And the rabbit model we developed will be useful in evaluating the effects of graft materials for anterior vertebral interbody fusion. Further study is needed to determine the most appropriate carrier for OMSCs and the feasibility in the clinical setting.
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Guppy KH, Harris J, Chen J, Paxton EW, Alvarez J, Bernbeck J. Reoperation rates for symptomatic nonunions in posterior cervical (subaxial) fusions with and without bone morphogenetic protein in a cohort of 1158 patients. J Neurosurg Spine 2016; 24:556-64. [DOI: 10.3171/2015.7.spine15353] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Bone morphogenetic protein (BMP) was first approved in 2002 for use in single-level anterior lumbar fusions as an alternative to iliac crest grafts. Subsequent studies have concluded that BMP provides superior fusions rates and therefore reduces reoperations for nonunions. The purpose of this study was to determine the reoperation rates for symptomatic nonunions in posterior cervical (subaxial) spinal fusions with and without the use of BMP and to determine if the nonunion rates are statistically significantly different between the two groups.
METHODS
Between January 2009 and September 2013, the authors identified 1158 posterior cervical spinal fusion cases in the subaxial spine (C2–7) from a large spine registry (Kaiser Permanente). Patient characteristics, diagnoses, operative times, lengths of stay, and reoperations were extracted from the registry. Reoperations for symptomatic nonunions were adjudicated via chart review. Logistic regression was conducted to produce estimates of odds ratios (OR) and 95% confidence intervals (CIs). Kaplan-Meier curves for the non-BMP and BMP groups were generated and compared using the log-rank test.
RESULTS
In this cohort there were 1158 patients (19.3% with BMP) with a median follow up of 1.7 years (interquartile range [IQR] 0.7–2.9 years) and median duration to operative nonunion of 0.63 years (IQR 0.44–1.57 years). Kaplan-Meier curves showed no significant difference in reoperation rates for nonunions using the log-rank test (p = 0.179). In a subset of patients with more than 1 year of follow-up, 788 patients were identified (22.5% with BMP) with a median follow-up duration of 2.5 years (IQR 1.7–3.4 years) and a median time to operative nonunion of 0.73 years (IQR 0.44–1.57 years). There was no statistically significant difference in the symptomatic operative nonunion rates for posterior cervical (subaxial) fusions with BMP compared with non-BMP (1.1% vs 0.7%; crude OR 1.73, 95% CI 0.32–9.55, p = 0.527) for more than 1 year of follow-up.
CONCLUSIONS
This study presents the largest series of patients using BMP in posterior cervical (subaxial) spinal fusions. Reoperation rates for symptomatic nonunions with more than 1 year of follow-up were found to be 1.1% with BMP and 0.7% without BMP. There was no significant difference in the reoperation rates for symptomatic nonunions with or without BMP.
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Affiliation(s)
- Kern H. Guppy
- 1Department of Neurosurgery, Kaiser Permanente Medical Group, Sacramento
| | - Jessica Harris
- 2Surgical Outcomes & Analysis Unit of Clinical Analysis, Kaiser Permanente, San Diego; and
| | - Jason Chen
- 2Surgical Outcomes & Analysis Unit of Clinical Analysis, Kaiser Permanente, San Diego; and
| | - Elizabeth W. Paxton
- 2Surgical Outcomes & Analysis Unit of Clinical Analysis, Kaiser Permanente, San Diego; and
| | - Julie Alvarez
- 2Surgical Outcomes & Analysis Unit of Clinical Analysis, Kaiser Permanente, San Diego; and
| | - Johannes Bernbeck
- 3Department of Orthopaedics, Kaiser Permanente Southern California, Baldwin Park, California
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Reintjes SL, Amankwah EK, Rodriguez LF, Carey CC, Tuite GF. Allograft versus autograft for pediatric posterior cervical and occipito-cervical fusion: a systematic review of factors affecting fusion rates. J Neurosurg Pediatr 2016; 17:187-202. [PMID: 26496632 DOI: 10.3171/2015.6.peds1562] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Fusion rates are high for children undergoing posterior cervical fusion (PCF) and occipito-cervical fusion (OCF). Autologous bone has been widely used as the graft material of choice, despite the risk of donor-site morbidity associated with harvesting the bone, possibly because very low fusion rates were reported with posterior allograft cervical fusions in children several decades ago. Higher overall fusion rates using allograft in adults, associated with improvements in internal fixation techniques and the availability of osteoinductive substances such as bone morphogenetic protein (BMP), have led to heightened enthusiasm for the use of bank bone during pediatric PCF. A systematic review was performed to study factors associated with successful bone fusion, including the type of bone graft used. METHODS The authors performed a comprehensive PubMed search of English-language articles pertaining to PCF and OCF in patients less than 18 years old. Of the 561 abstracts selected, 148 articles were reviewed, resulting in 60 articles that had sufficient detail to be included in the analysis. A meta-regression analysis was performed to determine if and how age, fusion technique, levels fused, fusion substrate, BMP use, postoperative bracing, and radiographic fusion criteria were related to the pooled prevalence estimates. A systematic review of the literature was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. RESULTS A total of 604 patients met the specific inclusion and exclusion criteria. The overall fusion rate was 93%, with a mean age of 9.3 years and mean follow-up of 38.7 months. A total of 539 patients had fusion with autograft (94% fusion rate) and 65 patients with allograft (80% fusion rate). Multivariate meta-regression analysis showed that higher fusion rates were associated with OCF compared with fusions that excluded the occiput (p < 0.001), with the use of autograft instead of allograft (p < 0.001), and with the use of CT to define fusion instead of plain radiography alone. The type of internal fixation, the use of BMP, patient age, and the duration of follow-up were not found to be associated with fusion rates in the multivariate analysis. CONCLUSIONS Fusion rates for PCF are high, with higher rates of fusion seen when autograft is used as the bone substrate and when the occiput is included in the fusion construct. Further study of the use of allograft as a viable alternative to autograft bone fusion is warranted because limited data are available regarding the use of allograft in combination with more rigid internal fixation techniques and osteoinductive substances, both of which may enhance fusion rates with allograft.
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Affiliation(s)
- Stephen L Reintjes
- Neuroscience Institute, and.,Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, Tampa, Florida; and
| | - Ernest K Amankwah
- Department of Clinical and Translational Research, All Children's Hospital/Johns Hopkins Medicine, St. Petersburg
| | - Luis F Rodriguez
- Neuroscience Institute, and.,Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, Tampa, Florida; and
| | - Carolyn C Carey
- Neuroscience Institute, and.,Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, Tampa, Florida; and
| | - Gerald F Tuite
- Neuroscience Institute, and.,Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, Tampa, Florida; and.,Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
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