ORCID Profile
0000-0002-4141-0116
Current Organisations
UNSW Sydney
,
SeaSpine
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Publisher: Elsevier BV
Date: 06-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 20-04-2023
DOI: 10.1097/BRS.0000000000004688
Abstract: Controlled animal study. To assess the cellular contribution of autograft to spinal fusion and determine the effects of intraoperative storage conditions on fusion. Autograft is considered the gold standard graft material in spinal fusion, purportedly due to its osteogenic properties. Autograft consists of adherent and non-adherent cellular components within a cancellous bone scaffold. However, neither the contribution of each component to bone healing is well understood nor are the effects of intraoperative storage of autograft. Posterolateral spinal fusion was performed in 48 rabbits. Autograft groups evaluated included: (1) Viable, (2) partially devitalized, (3) devitalized, (4) dried, and (5) hydrated iliac crest. Partially devitalized and devitalized grafts were rinsed with saline, removing nonadherent cells. Devitalized graft was, in addition, freeze/thawed, lysing adherent cells. For 90 minutes before implantation, air dried iliac crest was left on the back table whereas the hydrated iliac crest was immersed in saline. At 8 weeks, fusion was assessed through manual palpation, radiography, and microcomputed tomography. In addition, the cellular viability of cancellous bone was assayed over 4 hours. Spinal fusion rates by manual palpation were not statistically different between viable (58%) and partially devitalized (86%) autografts ( P = 0.19). Both rates were significantly higher than devitalized and dried autograft (both 0%, P 0.001). In vitro bone cell viability was reduced by 37% after 1 hour and by 63% after 4 hours when the bone was left dry ( P 0.001). Bone cell viability and fusion performance (88%, P 0.001 vs . dried autograft) were maintained when the graft was stored in saline. The cellular component of autograft is important for spinal fusion. Adherent graft cells seem to be the more important cellular component in the rabbit model. Autograft left dry on the back table showed a rapid decline in cell viability and fusion but was maintained with storage in saline.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 20-10-2020
Abstract: Despite the extensive use of cellular bone matrices (CBMs) in spine surgery, there is little evidence to support the contribution of cells within CBMs to bone formation. The objective of this study was to determine the contribution of cells to spinal fusion by direct comparisons among viable CBMs, devitalized CBMs, and cell-free demineralized bone matrix (DBM). Three commercially available grafts were tested: a CBM containing particulate DBM (CBM-particulate), a CBM containing DBM fibers (CBM-fiber), and a cell-free product with DBM fibers only (DBM-fiber). CBMs were used in viable states (CBM-particulate v and CBM-fiber v ) and devitalized (lyophilized) states (CBM-particulate d and CBM-fiber d ), resulting in 5 groups. Viable cell counts and bone morphogenetic protein-2 (BMP-2) content on enzyme-linked immunosorbent assay (ELISA) within each graft material were measured. A single-level posterolateral lumbar fusion was performed on 45 athymic rats with 3 lots of each product implanted into 9 animals per group. After 6 weeks, fusion was assessed using manual palpation, micro-computed tomography (μ-CT), and histological analysis. The 2 groups with viable cells were comparable with respect to cell counts, and pairwise comparisons showed no significant differences in BMP-2 content across the 5 groups. Manual palpation demonstrated fusion rates of 9 of 9 in the DBM-fiber specimens, 9 of 9 in the CBM-fiber d specimens, 8 of 9 in the CBM-fiber v specimens, and 0 of 9 in both CBM-particulate groups. The μ-CT maturity grade was significantly higher in the DBM-fiber group (2.78 ± 0.55) compared with the other groups (p 0.0001), while none of the CBM-particulate s les demonstrated intertransverse fusion in qualitative assessments. The viable and devitalized s les in each CBM group were comparable with regard to fusion rates, bone volume fraction, μ-CT maturity grade, and histological features. The cellular component of 2 commercially available CBMs yielded no additional benefits in terms of spinal fusion. Meanwhile, the groups with a fiber-based DBM demonstrated significantly higher fusion outcomes compared with the CBM groups with particulate DBM, indicating that the DBM component is probably the key determinant of fusion. Data from the current study demonstrate that cells yielded no additional benefit in spinal fusion and emphasize the need for well-designed clinical studies on cellular graft materials.
No related grants have been discovered for FRANK VIZESI.