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

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) PioneerMunish 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

a. Grants/Research Supportb. Consultantc. Stock/Shareholderd. Speakers’ Bureaue. Other Financial Support

18th International Meeting onAdvanced Spine Techniques

Authors Disclosure Information

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

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 Many factors can affect success of spine fusion

Patient co-morbiditiesPosition of implantMechanical 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

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 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

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

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 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

ResultsPre OP (mean)

1 – yr PostOP (mean)

P value

ODI 31.5 19.2 0.02

VAS 4.9 2.6 <0.01

SRS Function 3.0 3.8 <0.01

SRS Mental Health 3.3 3.8 .02

SRS Pain 2.7 3.5 <0.01

SRS Satisfaction 3.2 4.2 0.01

SRS Self Image 2.7 3.8 <0.01

SRS Total 3.0 3.8 <0.01

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.

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