Transcript Richard Hostin, MD

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
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
(a,b) DePuy Spine; (b) Allosource; (c) Pioneer
(b) DePuy Spine, Osteotech, Lanx; (c) DePuy Spine, J&J,
Pioneer, Proctor & Gamble, Acrotech, Pfizer; (d) AO,
Medtronic
(a) DePuy Spine
Shay Bess
Munish Gupta
International Spine Study Group
18th International Meeting on
Advanced Spine Techniques
Authors Disclosure Information
a.
b.
c.
d.
e.
Grants/Research Support
Consultant
Stock/Shareholder
Speakers’ Bureau
Other Financial Support
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-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
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
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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
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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
Results
Pre 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.
References
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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