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 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. - PowerPoint PPT Presentation
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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
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. 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.
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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