Papers by Keyword: Posterolateral Lumbar Fusion

Abstract: Posterolumbar fusion, which involves placing a bone graft in the posterolateral portion of the spine, has been applied to patients with lumbar instability due to structural defects or regressive degeneration. However, harvesting cancellous bone from the ilium is associated with severe postoperative pain, and patients experience more pain at the harvest site than at the graft site, thus resulting in poor patient satisfaction. If a tissue engineering approach was used to produce autogenous bone ex vivo with culture techniques, spinal fusion could be performed without damaging normal tissues. In all patients, 10 to 20 mL of bone marrow fluid was collected from the ilium and cultured in MEM containing autologous serum or fetal bovine serum and an antibiotic. After two weeks in primary culture, the marrow mesenchymal cells were seeded onto porous beta-TCP block, and tissue engineered bone were fabricated as we reported previously. Decompressive laminectomy and posterolateral lumbar fusion with use of the tissue engineered bone thus obtained were then done. In all patients, the implanted artificial bone survived and bone regeneration was detected radiographically, and the clinical symptoms were improved. Short term follow-up has shown that the bone implants were effective in all of the patients. There were no adverse reactions related to implantation. The use of this tissue engineered bone makes it possible to perform osteogenetic treatment without harvesting autogenous bone, thus avoiding pain and pelvic deformity at the site of bone collection and reducing the burden on the patient.

Abstract: Transplantation surgeries of autologous bone require a second surgery with inherent risks. To avoid these risks, we developed a multi porous implant of hydroxyapatite/collagen composite with desirable biophysical properties (flexibility, elasticity and compression resistance) for use with OP-1 as a graft implant. In this study, we tested the efficacy of this multi porous implant as OP-1 carrier using rabbit posterolateral lumbar fusion model (PLF). PLFs were performed in the following 4 groups of 8 New Zealand white rabbits each: autograft, HAp/Col alone, HAp/Col plus 0.3 mg OP-1, and HAp/Col plus 1.2 mg OP-1. At 5 weeks, fusion masses were analyzed by radiographic and biomechanical tests. Implants consisting of HAp/Col plus OP-1 were more effective than autologous bone in promoting spinal fusion. Low dose and high dose OP-1 were equally effective.