P136. Randomized, prospective clinical trial to evaluate efficacy and safety in lumbar fusion surgery of implantation of autologous bone marrow mesenchymal cells expanded ex vivo and combined with allogeneic bone tissue, compared with autologous iliac crest graft; part II: clinical findings

Object Considerable biological research has been performed to aid bone healing in conjunction with lumbar fusion surgery. Iliac crest autograft is often considered the gold standard because it has the vital properties of being osteoconductive, osteoinductive, and osteogenic. However, graft site pain has been widely reported as the most common donor site morbidity. Autograft site pain has led many companies to develop an abundance of bone graft extenders, which have limited proof of efficacy. During the surgical consent process, many patients ask surgeons to avoid harvesting autograft because of the reported pain complications. The authors sought to study postoperative graft site pain by simply asking patients whether they knew which iliac crest was grafted when a single skin incision was made for the fusion operation. Methods Twenty-five patients underwent iliac crest autografting with allograft reconstruction during instrumented lumbar fusion surgery. In all patients the autograft was harvested through the same skin incision but with a separate fascial incision. At various points postoperatively, the patients were asked if they could tell which iliac crest had been harvested, and if so, how much pain did it cause (10-point Numeric Rating Scale). Results Most patients (64%) could not correctly determine which iliac crest had been harvested. Of the 9 patients who correctly identified the side of the autograft, 7 were only able to guess. The 2 patients who confidently identified the side of grafting had no pain at rest and mild pain with activity. One patient who incorrectly guessed the side of autografting did have significant sacroiliac joint degenerative pain bilaterally. Conclusions Results of this study indicate the inability of patients to clearly define their graft site after iliac crest autograft harvest with allograft reconstruction of the bony defect unless they have a separate skin incision. This simple, easily reproducible pilot study can be expanded into a larger, multiinstitutional investigation to provide more definitive answers regarding the ideal, safe, and cost-effective bone graft material to be used in spinal fusions.

Download Full-text

Approach-related anatomical differences in patients with lumbo-sacral transitional vertebrae undergoing lumbar fusion surgery at level L4/5

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-04303-2 ◽

2022 ◽

Author(s):

Luis Becker ◽

Dominik Adl Amini ◽

Katharina Ziegeler ◽

Maximilian Muellner ◽

Torsten Diekhoff ◽

...

Keyword(s):

Vascular Injury ◽

Iliac Crest ◽

Lumbar Fusion ◽

Vena Cava ◽

Lumbar Vertebrae ◽

Psoas Muscle ◽

Lateral Approach ◽

Surgical Approaches ◽

Control Group ◽

Fusion Surgery

Abstract Introduction Lumbo-sacral transitional vertebrae (LSTV) are accompanied by changes in soft tissue anatomy. The aim of our retrospective study was to evaluate the effects of LSTV as well as the number of free lumbar vertebrae on surgical approaches of ALIF, OLIF and LLIF at level L4/5. Material and methods We assessed the CTs of 819 patients. Of these, 53 had LSTV from which 11 had six (6LV) and 9 four free lumbar vertebrae (4LV). We matched them for sex and age to a control group. Results Patients with LSTV had a higher iliac crest and vena cava bifurcation, a greater distance between the common iliac veins and an anterior translation of the psoas muscle at level L4/5. In contrast, patients with 6LV had a lower iliac crest and aortic bifurcation, no differences in vena cava bifurcation and distance between the iliac veins compared to the control group. Conclusions For patients with LSTV and five or four free lumbar vertebrae, the LLIF approach at L4/5 may be hindered due to a high riding iliac crest as well as anterior shift of the psoas muscle. Whereas less mobilization and retraction of the iliac veins may reduce the risk of vascular injury at this segment by ALIF and OLIF. For patients with 6LV, a lower relative height of the iliac crest facilitates lateral approach during LLIF. For ALIF and OLIF, a stronger vessel retraction due to the deeper-seated vascular bifurcation is necessary during ALIF and is therefore potentially at higher risk for vascular injury.

Download Full-text

Navigation of iliac crest graft harvest using markerless augmented reality and cutting guide technology: A pilot study

International Journal of Medical Robotics and Computer Assisted Surgery ◽

10.1002/rcs.2318 ◽

2021 ◽

Author(s):

Philipp Winnand ◽

Nassim Ayoub ◽

Tim Redick ◽

Jonas Gesenhues ◽

Marius Heitzer ◽

...

Keyword(s):

Pilot Study ◽

Augmented Reality ◽

Iliac Crest ◽

Iliac Crest Graft ◽

Cutting Guide ◽

Graft Harvest

Download Full-text

The influence of frailty on postoperative complications in geriatric patients receiving single-level lumbar fusion surgery

European Spine Journal ◽

10.1007/s00586-021-06960-8 ◽

2021 ◽

Author(s):

Shane Shahrestani ◽

Andy Ton ◽

Xiao T. Chen ◽

Alexander M. Ballatori ◽

Jeffrey C. Wang ◽

...

Keyword(s):

Postoperative Complications ◽

Geriatric Patients ◽

Lumbar Fusion ◽

Fusion Surgery ◽

Single Level ◽

Lumbar Fusion Surgery

Download Full-text

Lumbar Fusion Surgery for Patients With Back Pain and Degenerative Disc Disease: An Observational Study From the Canadian Spine Outcomes and Research Network

Global Spine Journal ◽

10.1177/2192568220985470 ◽

2021 ◽

pp. 219256822098547

Author(s):

Nathan Evaniew ◽

Ganesh Swamy ◽

W. Bradley Jacobs ◽

Jacques Bouchard ◽

Roger Cho ◽

...

Keyword(s):

Back Pain ◽

Degenerative Disc Disease ◽

Short Form ◽

Lumbar Fusion ◽

Research Network ◽

Disc Disease ◽

Fusion Surgery ◽

Degenerative Disc ◽

Lumbar Fusion Surgery ◽

Related Quality

Study Design: Uncontrolled retrospective observational study. Objectives: Surgery for patients with back pain and degenerative disc disease is controversial, and studies to date have yielded conflicting results. We evaluated the effects of lumbar fusion surgery for patients with this indication in the Canadian Spine Outcomes and Research Network (CSORN). Methods: We analyzed data that were prospectively collected from consecutive patients at 11 centers between 2015 and 2019. Our primary outcome was change in patient-reported back pain at 12 months of follow-up, and our secondary outcomes were satisfaction, disability, health-related quality of life, and rates of adverse events. Results: Among 84 patients, we observed a statistically significant improvement of back pain at 12 months that exceeded the threshold of Minimum Clinically Important Difference (MCID) (mean change -3.7 points, SD 2.6, p < 0.001, MCID = 1.2; 77% achieved MCID), and 81% reported being “somewhat” or “extremely” satisfied. We also observed improvements of Oswestry Disability Index (-17.3, SD 16.6), Short Form-12 Physical Component Summary (10.3, SD 9.6) and Short Form-12 Mental Component Summary (3.1, SD 8.3); all p < 0.001). The overall rate of adverse events was 19%. Conclusions: Among a highly selective group of patients undergoing lumbar fusion surgery for degenerative disc disease, most experienced a clinically significant improvement of back pain as well as significant improvements of disability and health-related quality of life, with high satisfaction at 1 year of follow-up. These findings suggest that surgery for this indication may provide some benefit, and that further research is warranted.

Download Full-text

Virtual Surgical Planning, Stereolitographic Models and CAD/CAM Titanium Mesh for Three-Dimensional Reconstruction of Fibula Flap with Iliac Crest Graft and Dental Implants

Journal of Clinical Medicine ◽

10.3390/jcm10091922 ◽

2021 ◽

Vol 10 (9) ◽

pp. 1922

Author(s):

Carlos Navarro Cuéllar ◽

Manuel Tousidonis Rial ◽

Raúl Antúnez-Conde ◽

Santiago Ochandiano Caicoya ◽

Ignacio Navarro Cuéllar ◽

...

Keyword(s):

Bone Resorption ◽

Surgical Planning ◽

Iliac Crest ◽

Three Dimensional ◽

Titanium Mesh ◽

Iliac Crest Graft ◽

Virtual Surgical Planning ◽

Fibula Flap ◽

Dimensional Reconstruction ◽

Cad Cam

Mandibular reconstruction with fibula flap shows a 3D discrepancy between the fibula and the remnant mandible. Eight patients underwent three-dimensional reconstruction of the fibula flap with iliac crest graft and dental implants through virtual surgical planning (VSP), stereolitographic models (STL) and CAD/CAM titanium mesh. Vertical ridge augmentation and horizontal dimensions of the fibula, peri-implant bone resorption of the iliac crest graft, implant success rate and functional and aesthetic results were evaluated. Vertical reconstruction ranged from 13.4 mm to 10.1 mm, with an average of 12.22 mm. Iliac crest graft and titanium mesh were able to preserve the width of the fibula, which ranged from 8.9 mm to 11.7 mm, with an average of 10.1 mm. A total of 38 implants were placed in the new mandible, with an average of 4.75 ± 0.4 implants per patient and an osseointegration success rate of 94.7%. Two implants were lost during the osseointegration period (5.3%). Bone resorption was measured as peri-implant bone resorption at the mesial and distal level of each implant, with a variation between 0.5 mm and 2.4 mm, and with a mean of 1.43 mm. All patients were rehabilitated with a fixed implant prosthesis with good aesthetic and functional results.

Download Full-text

Development of a gel dedicated to gel immersion endoscopy

Endoscopy International Open ◽

10.1055/a-1396-4236 ◽

2021 ◽

Vol 09 (06) ◽

pp. E918-E924

Author(s):

Tomonori Yano ◽

Atsushi Ohata ◽

Yuji Hiraki ◽

Makoto Tanaka ◽

Satoshi Shinozaki ◽

...

Keyword(s):

Electrical Conductivity ◽

Porcine Model ◽

Ex Vivo ◽

In Vitro Experiments ◽

Efficacy And Safety ◽

Coagulative Necrosis ◽

Novel Technique ◽

In Vivo Experiments

Abstract Backgrounds and study aims Gel immersion endoscopy is a novel technique to secure the visual field during endoscopy. The aim of this study was to develop a dedicated gel for this technique. Methods To identify appropriate viscoelasticity and electrical conductivity, various gels were examined. Based on these results, the dedicated gel “OPF-203” was developed. Efficacy and safety of OPF-203 were evaluated in a porcine model. Results In vitro experiments showed that a viscosity of 230 to 1900 mPa·s, loss tangent (tanδ) ≤ 0.6, and hardness of 240 to 540 N/cm2 were suitable. Ex vivo experiments showed electrical conductivity ≤ 220 μS/cm is appropriate. In vivo experiments using gastrointestinal bleeding showed that OPF-203 provided clear visualization compared to water. After electrocoagulation of gastric mucosa in OPF-203, severe coagulative necrosis was not observed in the muscularis but limited to the mucosa. Conclusions OPF-203 is useful for gel immersion endoscopy.

Download Full-text