scholarly journals Septic hematogenous lumbar spondylodiscitis in elderly patients with multiple risk factors: efficacy of posterior stabilization and interbody fusion with iliac crest bone graft

2010 ◽  
Vol 19 (10) ◽  
pp. 1720-1727 ◽  
Author(s):  
Ralf G. Hempelmann ◽  
Eckhardt Mater ◽  
Ralph Schön
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Bone Graft ◽  
Interbody Fusion ◽  
Iliac Crest ◽  
Iliac Crest Bone Graft ◽  
Posterior Stabilization ◽  
Multiple Risk Factors ◽  
Multiple Risk

Survival after Complete Response to Treatment with Laromustine (CLORETAZINE®) in Elderly Patients with De Novo Poor Risk Acute Myelogenous Leukemia (AML).

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 940-940
Author(s):  
Susan O’Brien ◽  
Gary Schiller ◽  
Robert Kenneth Stuart ◽  
Diana Hudak ◽  
Francis Giles
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Clinical Benefit ◽  
Older Patients ◽  
De Novo ◽  
Myelogenous Leukemia ◽  
Multiple Risk Factors ◽  
Poor Risk ◽  
Kaplan Meier ◽  
Multiple Risk

Abstract Background: Treatment options for patients with AML are limited. Poor outcomes are associated with increasing age, decreasing performance status, unfavorable cytogenetics, and the presence of comorbid conditions. Elderly patients ³ 65 years with AML have a short survival (median 2.4 months) (Lang 2005), and for older patients who receive treatment, 1-year survival is 5–25% (Menzin 2002, Kantarjian 2006, Burnett 2007). CR/CRp is a desired outcome from induction treatment and a requisite for meaningful survival. Laromustine (Cloretazine) is a novel sulfonylhydrazine alkylating agent which preferentially targets the O6 position of guanine resulting in DNA cross-links. Results of two sequential Phase II multi-center studies of single agent laromustine (CLI-033 and CLI-043) conducted in elderly untreated AML patients have been reported (Giles 2007, Schiller 2008). The purpose of this analysis is to assess survival for a combined group of patients from the two studies who achieved a response to laromustine (CR/CRp by IWG criteria [Cheson 2003]). Methods: Eighty-five patients in study CLI-043 and 55 patients from a retrospectively identified de novo subset of CLI-033 who reasonably met the eligibility criteria for CLI- 043, received laromustine 600 mg/m2 as induction therapy (N=140). Poor risk was defined as the presence of at least one risk factor: age ³ 70 yrs, unfavorable cytogenetics, PS2, or pulmonary, cardiac, or hepatic comorbidity. 86% (120/140) pts had 2 or more risk factors. 16% (22/140) pts received a second induction of laromustine 600 mg/m2. 24% (34/140) patients received a consolidation cycle; per individual protocol, 15 pts received consolidation with laromustine 400 mg/m2 and 19 pts received cytarabine 400 mg/ m2. Kaplan-Meier analysis of survival was used to better understand the clinical benefit of CR/CRp. Results: 52/140 (37%) pts achieved a CR/CRp; 44/140 (31%) pts survived ³ 30 days following CR/CRp. All but one patient achieved CR/CRp following first induction. Estimated Kaplan-Meier survival from time of response for these 44 patients is shown below. Six and 12 month survival for this subset is 58% and 44%, respectively. The 30-day mortality for the entire group is 14% (20/140). Figure Figure Conclusions: Early mortality, progressive disease, and short CR/CRp duration account for short median survival rates in leukemia studies. The 30-day mortality for this group compares favorably with published data of early death rates in older patients with multiple risk factors who receive induction chemotherapy (Appelbaum 2006, Kantarjian 2006). Relatively long survival in a subset of older patients with multiple risk factors who achieve a response to laromustine implies clinical benefit, and confirms the concept that obtaining a CR/CRp is in itself a benefit.

Influence of cage design on interbody fusion in a sheep cervical spine model

2002 ◽  
Vol 96 (3) ◽  
pp. 321-332 ◽  
Author(s):  
Frank Kandziora ◽  
Georg Schollmeier ◽  
Matti Scholz ◽  
Jan Schaefer ◽  
Alexandra Scholz ◽  
...  
Keyword(s):  
Bone Graft ◽  
Bone Mineral ◽  
Interbody Fusion ◽  
Iliac Crest ◽  
Bone Matrix ◽  
Iliac Crest Bone Graft ◽  
Disc Space ◽  
Content Type ◽  
Flexion Extension ◽  
Fine Print

Object. The purpose of this study was to compare the characteristics of interbody fusion achieved using an autologous tricortical iliac crest bone graft with those of a cylinder- and a box-design cage in a sheep cervical spine model. This study was designed to determine whether there are differences between three interbody fusion procedures in: 1) ability to preserve postoperative distraction; 2) biomechanical stability; and 3) histological characteristics of intervertebral bone matrix formation. Methods. Twenty-four sheep underwent C3–4 discectomy and fusion in which the following were used: Group 1, autologous tricortical iliac crest bone graft (eight sheep); Group 2, titanium cylinder-design cage filled with autologous iliac crest bone graft (eight sheep); and Group 3, titanium box-design cage filled with autologous iliac crest graft (eight sheep). Radiography was performed pre- and postoperatively and after 1, 2, 4, 8, and 12 weeks. At the same time points, disc space height, intervertebral angle, and lordosis angle were measured. After 12 weeks, the sheep were killed, and fusion sites were evaluated by obtaining functional radiographs in flexion and extension. Quantitative computerized tomography scans were acquired to assess bone mineral density, bone mineral content, and bone callus volume. Biomechanical testing was performed in flexion, extension, axial rotation, and lateral bending. Stiffness, range of motion, neutral zone, and elastic zone were determined. Histomorphological and histomorphometric analyses were performed, and polychrome sequential labeling was used to determine the time frame of new bone formation. Over a 12-week period significantly higher values for disc space height and intervertebral angle were shown in cage-treated sheep than in those that received bone graft. Functional radiographic assessment revealed significantly lower residual flexion—extension movement in sheep with the cylinder cage-fixed spines than in those that received bone graft group. The cylinder—design cages showed significantly higher values for bone mineral content, bone callus content, and stiffness in axial rotation and lateral bending than the other cages or grafts. Histomorphometric evaluation and polychrome sequential labeling showed a more progressed bone matrix formation in the cylindrical cage group than in both other groups. Conclusions. Compared with the tricortical bone graft, both cages showed significantly better distractive properties. The cylindrical cage demonstrated a significantly higher biomechanical stiffness and an accelerated interbody fusion compared with the box-design cage and the tricortical bone graft. The differences in bone matrix formation within both cages were the result of the significantly lower stress shielding on the bone graft by the cylinder-design cage.

Iliac Crest Bone Graft for Minimally Invasive Transforaminal Lumbar Interbody Fusion

Spine ◽  
2018 ◽  
pp. 1 ◽  
Author(s):  
Brittany E. Haws ◽  
Benjamin Khechen ◽  
Ankur S. Narain ◽  
Fady Y. Hijji ◽  
Kaitlyn L. Cardinal ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Bone Graft ◽  
Interbody Fusion ◽  
Iliac Crest ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Iliac Crest Bone Graft ◽  
Lumbar Interbody Fusion

Peptide Enhanced Bone Graft Substitute Presents Improved Short-Term Increase in Bone Volume and Construct Stiffness Compared to Iliac Crest Autologous Bone in an Ovine Lumbar Interbody Fusion Model

2021 ◽  
pp. 219256822097983
Author(s):  
Arjan C. Y. Loenen ◽  
Jerome Connor ◽  
Scott Johnson ◽  
Katherine Davis ◽  
Nolan Hannigan ◽  
...  
Keyword(s):  
Bone Graft ◽  
Bone Remodeling ◽  
Interbody Fusion ◽  
Iliac Crest ◽  
Bone Graft Substitute ◽  
Iliac Crest Bone Graft ◽  
Graft Material ◽  
Lumbar Interbody Fusion ◽  
Ovine Model ◽  
Systemic Health

Study design: Preclinical ovine model. Objective: To assess the in vivo efficacy and safety of the P-15 L bone graft substitute and compare its performance to autologous iliac crest bone graft (ICBG) for lumbar interbody fusion indications. Methods: Thirty skeletally mature sheep underwent lumbar interbody fusion surgery. Half of the sheep received autologous ICBG and the other half the peptide enhanced bone graft substitute (P-15 L). Following termination at 1, 3, and 6 months after surgery, the operated segments were analyzed using micro computed tomography (µCT), histology, and destructive mechanical testing. Additional systemic health monitoring was performed for the P-15 L group. Results: One month after surgery, there was only minor evidence of bone remodeling and residual graft material could be clearly observed within the cage. There was active bone remodeling between 1 and 3 months after surgery. At 3 months after surgery significantly denser and stiffer bone was found in the P-15 L group, whereas at 6 months, P-15 L and ICBG gave similar fusion results. The P-15 L bone graft substitute did not have any adverse effects on systemic health. Conclusions: The drug device combination P-15 L was demonstrated to be effective and save for lumbar interbody fusion as evidenced by this ovine model. Compared to autologous ICBG, P-15 L seems to expedite bone formation and remodeling but in the longer-term fusion results were similar.

scholarly journals Microcomputed tomographic, biomechanical and histological analyses of lumbar interbody fusion with iliac crest bone graft in a pig model

2021 ◽  
Vol 90 (1) ◽  
pp. 69-75
Author(s):  
Milan Krtička ◽  
Vladimír Nekuda ◽  
Daniel Ira ◽  
Radek Sedláček ◽  
Tomáš Suchý ◽  
...  
Keyword(s):  
Bone Graft ◽  
Interbody Fusion ◽  
Iliac Crest ◽  
Biomechanical Analysis ◽  
Iliac Crest Bone Graft ◽  
Testing System ◽  
Lumbar Interbody Fusion ◽  
Micro Ct ◽  
Histological Assessment ◽  
Load Limit

The main goal of this study was to assess the progress of vertebral stability after lumbar interbody fusion related to microcomputed tomography (micro CT), biomechanical analysis, and histological assessment towards spine fusion. Twelve male pigs were used; each underwent L2-3 discectomy and implantation of an iliac crest bone graft in two groups; six spines were harvested eight weeks (A1) and six spines 16 weeks (A2) after surgery (7 native spines for biomechanical analysis). The CT was performed by GE phoenix datos|x 2.0 with a sample drift correction. The samples were divided according to fusion quality. Biomechanical evaluation was carried out on the MTS Mini Bionix testing system. In the nondestructive mode, three cycles of pure bending moments were applied (5 Nm load limit) at a rate of 20 °/min in flexion (+40 °) and extension (-40 °). Two representative histological sections from four samples were obtained (A1, n = 2; A2, n = 2); areas of mature bone were quantified. In micro CT, better results were achieved in group A2 (not significant). Eight weeks after the operation, flexural stiffness decreased to 48% of its initial value for native cadavers (P < 0.05); after 16 weeks it was comparable to native cadavers, demonstrating the suitability of the implanted graft (P < 0.05). The newly formed bone tissue occupied an average area of 94.205 mm2 (A1) and 26.240 mm2 (A2). It was confirmed that micro CT, biomechanical analysis, and histological assessment are technically feasible and suitable for the evaluation of results of other methods of large bone defect treatment.

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