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E-Poster #510 Mineralized Collagen and Bone Marrow Aspirate in Anterior Interbody Carbon Fiber Cages Achieve High Fusion Rates in Multilevel Adult Spinal Deformity. Richard Hostin, M.D.; Eric Klineberg, M.D.; Shay Bess, M.D.; Munish Gupta, M.D.; International Spine Study Group.

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slide1

E-Poster #510 Mineralized Collagen and Bone Marrow Aspirate in Anterior Interbody Carbon Fiber Cages Achieve High Fusion Rates in Multilevel Adult Spinal Deformity

Richard Hostin, M.D.; EricKlineberg, M.D.; Shay Bess, M.D.; Munish Gupta, M.D.; International Spine Study Group

slide2

E-Poster #510 Mineralized collagen and bone marrow. . .

Presenter: Richard Hostin (a,d) DePuy Spine; (e) Axial Biotech

Co-Authors: Eric Klineberg (a) OREF; (b) Synthes; (d) DePuy Spine, Stryker, Synthes

(e) AO

Shay Bess (a,b) DePuy Spine; (b) Allosource; (c) Pioneer

Munish Gupta (b) DePuy Spine, Osteotech, Lanx; (c) DePuy Spine, J&J, Pioneer, Proctor & Gamble, Acrotech, Pfizer; (d) AO, Medtronic

International Spine Study Group (a) DePuy Spine

  • Grants/Research Support
  • Consultant
  • Stock/Shareholder
  • Speakers’ Bureau
  • Other Financial Support

18th International Meeting on

Advanced Spine Techniques

Authors Disclosure Information

summary
Summary
  • Single-center, blinded radiographic and patient outcome analysis of multilevel anterior spine fusion rates using bone marrow aspirate and mineralized collagen in anterior interbody fusion cages in adult spinal deformity patients.
  • Fusion grades based on published Lenke-Bridwell grading scale
    • 1 – Complete fusion
    • 2 – Probable fusion with no lucencies
    • 3 – an intact graft with lucency at the top or bottom of the graft
    • 4 – nonunion with resorption of the graft
introduction
Introduction
  • Many factors can affect success of spine fusion
    • Patient co-morbidities
    • Position of implant
    • Mechanical and/or biological deficiencies
  • Debate continues regarding the “proper” method of assessing union with bone graft replacements as well as the cost vs benefit of available osteobiologics
introduction1
Introduction
  • Surgical exploration and radiographic analysis continue to be acceptable options for evaluating fusion success
  • Purpose:To determine the ability of bone marrow aspirate and mineralized collagen placed in carbon fiber polymer cages to achieve multilevel anterior fusion in adult spinal deformity patients.
methods
Methods
  • Prospective, consecutive, adult spinal deformity patients who required long fusions to the pelvis underwent multilevel anterior spine fusion using bone marrow aspirate/mineralized collagen and a carbon fiber interbody device, combined with instrumented posterior spinal fusion
  • Radiographic analysis included preop and minimum 1 year postop full length coronal and sagittal radiographs, lumbar flexion/extension radiographs and postop lumbar CT scans
methods1
Methods
  • Anterior spine fusion status at each level (T11-S1) evaluated minimum 1 year postoperatively by 3 independent surgeons using the Bridwell-Lenke grading scale
  • Grades <2.5 classified as fused
  • Grades >2.5 classified as not fused
  • Pre and post op HRQOL measures included: VAS, SRS-22, and ODI
methods2
Methods

Statistical analysis:

Comparison analysis using paired t-tests was performed with minimum of 1 year follow up

Changes in ODI scores from preoperative to 1 year postop decreased significantly by an average of 12.53 (p=0.02)

Changes in ODI scores from preop to 2 year post op decreased significantly by an average of 10.80 (p=0.02)

There was no statistical change in ODI scores between the two post op periods (year 1 to year 2)

Similar results were observed for SRS and VAS scores

results
Results
  • From 2006-2008, 23 adult spinal deformity patients received 109 anterior spine fusions (mean 4.7 levels/patient)
  • Follow up = 1.6 years
  • 95% of levels were classified as fused on plain radiographs
  • 86% of levels classified as fused on CT
  • Improvement demonstrated for all HRQOL measures
  • No statistically significant differences in outcome measures between patients classified as fused versus non-fused
conclusion
Conclusion
  • Bone marrow aspirate/mineralized collagen demonstrates high fusion rates and improved patient outcomes for multilevel anterior spine fusions at intermediate follow-up.
  • Bone marrow aspirate/mineralized collagen is a viable osteobiologic alternative for anterior spine fusion in adult spine deformity patients receiving combined anterior and posterior spinal fusion.
references
References
  • Bridwell and Lenke et al., Spine, 20: 1410-1418, 1995
  • Mulconrey and Lenke et al., Spine, 33: 2153-2159, 2008
  • Eck and Lenke et al., J Spin Disord, 13: 501-509, 2000
  • Tan et al., Eur Spine J, 16:1875-1881, 2007
  • Shah RR and Taylor, Eur Spine J, 12: 378-385, 2003
  • Neen et al., Spine, 31: E636-E640, 2006
  • Tay et al., Spine, 23: 2276-2281, 1998
  • Zdeblick, Spine, 18: 983-991, 1993
  • Brantigan and Steffee, Spine, 18: 2106-2117, 1992
  • Akbarnia et al., Orthopedic Transactions, 17: 123, 1993
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