E-Poster #510 Mineralized Collagen and Bone Marrow Aspirate in Anterior Interbody Carbon Fiber Cages...
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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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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


E-Poster #510 Mineralized collagen and bone marrow. . . in Anterior Interbody Carbon Fiber Cages Achieve High Fusion Rates in Multilevel Adult Spinal Deformity

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 in Anterior Interbody Carbon Fiber Cages Achieve High Fusion Rates in Multilevel Adult Spinal Deformity

  • 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 in Anterior Interbody Carbon Fiber Cages Achieve High Fusion Rates in Multilevel Adult Spinal Deformity

  • 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 in Anterior Interbody Carbon Fiber Cages Achieve High Fusion Rates in Multilevel Adult Spinal Deformity

  • 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 in Anterior Interbody Carbon Fiber Cages Achieve High Fusion Rates in Multilevel Adult Spinal Deformity

  • 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 in Anterior Interbody Carbon Fiber Cages Achieve High Fusion Rates in Multilevel Adult Spinal Deformity

  • 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 in Anterior Interbody Carbon Fiber Cages Achieve High Fusion Rates in Multilevel Adult Spinal Deformity

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 in Anterior Interbody Carbon Fiber Cages Achieve High Fusion Rates in Multilevel Adult Spinal Deformity

  • 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


Results1
Results in Anterior Interbody Carbon Fiber Cages Achieve High Fusion Rates in Multilevel Adult Spinal Deformity


Conclusion
Conclusion in Anterior Interbody Carbon Fiber Cages Achieve High Fusion Rates in Multilevel Adult Spinal Deformity

  • 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 in Anterior Interbody Carbon Fiber Cages Achieve High Fusion Rates in Multilevel Adult Spinal Deformity

  • 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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