Autologous Stem Cells in Cervical Spine Fusion

Study Design: Systematic review. Objectives: To systematically review, critically appraise and synthesize evidence on use of stem cells from autologous stem cells from bone marrow aspirate, adipose, or any other autologous sources for fusion in the cervical spine compared with other graft materials. Methods: A systematic search of PubMed/MEDLINE was conducted for literature published through October 31, 2018 and through February 20, 2020 for EMBASE and ClinicalTrials.gov comparing autologous cell sources for cervical spine fusion to other graft options. Results: From 36 potentially relevant citations identified, 10 studies on cervical fusion met the inclusion criteria set a priori. Two retrospective cohort studies, one comparing cancellous bone marrow (CBM) versus hydroxyapatite (HA) and the other bone marrow aspirate (BMA) combined with autograft and HA versus autograft and HA alone, were identified. No statistical differences were seen between groups in either study for improvement in function, symptoms, or fusion; however, in the study evaluating BMA, the authors reported a statistically greater fusion rate and probability of fusion over time in the BMA versus the non-BMA group. Across case series evaluating BMA, authors reported improved function and pain and fusion ranged from 84% to 100% across the studies. In general, complications were poorly reported. Conclusions: The overall quality (strength) of evidence of effectiveness and safety of autologous BMA for cervical arthrodesis in the current available literature was very low. Based on currently available data, firm conclusions regarding the effectiveness or safety of BMA in cervical fusions cannot be made.

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How stem cell composition in bone marrow aspirate relates to clinical outcomes when used for cervical spine fusion

PLoS ONE ◽

10.1371/journal.pone.0203714 ◽

2018 ◽

Vol 13 (9) ◽

pp. e0203714 ◽

Cited By ~ 4

Author(s):

Christopher D. Chaput ◽

Adam Shar ◽

Daniel Jupiter ◽

Zach Hubert ◽

Bret Clough ◽

...

Keyword(s):

Bone Marrow ◽

Stem Cell ◽

Cervical Spine ◽

Clinical Outcomes ◽

Bone Marrow Aspirate ◽

Spine Fusion ◽

Cell Composition ◽

Cervical Spine Fusion

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Phases 1–3 Clinical Trials Using Adult Stem Cells in Osteonecrosis and Nonunion Fractures

Stem Cells International ◽

10.4061/2010/410170 ◽

2010 ◽

Vol 2010 ◽

pp. 1-4 ◽

Cited By ~ 10

Author(s):

Jean-Philippe Hauzeur ◽

Valérie Gangji

Keyword(s):

Stem Cells ◽

Bone Marrow ◽

Adult Stem Cells ◽

Bone Marrow Aspirate ◽

Direct Injection ◽

Case Series ◽

Autologous Bone Marrow ◽

Bone Necrosis ◽

Concentrated Bone Marrow ◽

Made In

Nonunion fractures and aseptic bone necrosis are two pathological conditions having some impairment of the cellular part of the repair: a reduction of MSC and of the osteoblastic activation. Both are good candidates for cell-based therapies using stem cells. We made a review of the published human trials. Only autologous bone marrow aspirate implantation was until now used. In Nonunion, a direct injection—15 to 150 ml—was made in 4 case series studies. In another, the bone marrow aspirate was concentrated before injection. The results were good. In bone necrosis, only one level 1 study was published. The results at 24 months were positive in terms of reduction of the necrosis and appearance of collapse. In 3 case series studies, a treatment with concentrated bone marrow aspirates was deemed useful with good results in 76 to 96%. These results are interesting but need confirmation by controlled studies.

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Use of Allogenic Mesenchymal Cellular Bone Matrix in Anterior and Posterior Cervical Spinal Fusion: A Case Series of 21 Patients

Asian Spine Journal ◽

10.4184/asj.2017.11.3.454 ◽

2017 ◽

Vol 11 (3) ◽

pp. 454-462 ◽

Cited By ~ 7

Author(s):

Srikanth Naga Divi ◽

Mark M. Mikhael

Keyword(s):

Cervical Spine ◽

High Risk ◽

Bone Matrix ◽

Case Series ◽

Leisure Activity ◽

Spine Fusion ◽

Cervical Fusion ◽

Medical Comorbidities ◽

Cervical Spine Fusion ◽

Cellular Bone

<sec><title>Study Design</title>Retrospective case series.</sec><sec><title>Purpose</title>To report our early experience using allogenic mesenchymal cellular bone matrix (CBM) products in cervical spine fusion.</sec><sec><title>Overview of Literature</title>Multi-level cervical fusions have historically yielded lower fusion rates than single level fusions, especially in patients with high risk medical comorbidities. At this time, significant literature in cervical fusion outcomes with this cellular allograft technology is lacking.</sec><sec><title>Methods</title>Twenty-one patients underwent either multilevel (3 or 4 level) anterior cervical discectomy and fusion, anterior cervical corpectomy and fusion, or posterior cervical fusion. ViviGen (DePuy Synthes Spine, Raynham, MA, USA), an allogenic bone matrix product, was used in addition to standard instrumentation. Radiographic evaluation was performed at 2 weeks, 12 weeks, 24 weeks and 1 year postoperative. Visual analog scale (VAS) and neck disability index (NDI) scores along with return to work and leisure activity were recorded.</sec><sec><title>Results</title>At 6 months postoperative, all patients had radiographic evidence of bone fusion regardless of age or medical comorbidities. All patients reported subjective improvement with a mean decrease in VAS from 8.3 to 1.5 and a mean decrease in NDI from 40.3% to 6.0% at 1 year. All patients also returned to work and/or regular leisure activity within 3 months.</sec><sec><title>Conclusions</title>Twenty-one patients undergoing high-risk anterior and posterior cervical spine fusion, with the use of a commercially available mesenchymal CBM product, went on to radiographic fusion and all had improvement in subjective outcomes. While further effort and research is needed to validate its widespread use, this study shows favorable use of CBM in cervical fusion for high-risk cases.</sec>

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Congenital cervical spine fusion and airway management: a case series of Klippel-Feil syndrome

Journal of Clinical Anesthesia ◽

10.1016/j.jclinane.2008.04.009 ◽

2008 ◽

Vol 20 (6) ◽

pp. 447-451 ◽

Cited By ~ 24

Author(s):

Meghan L. Stallmer ◽

Vishnu Vanaharam ◽

George A. Mashour

Keyword(s):

Cervical Spine ◽

Airway Management ◽

Case Series ◽

Spine Fusion ◽

Cervical Spine Fusion

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Posterior cervical spine fusion with tension-band wiring

Journal of Neurosurgery ◽

10.3171/jns.1995.83.4.0631 ◽

1995 ◽

Vol 83 (4) ◽

pp. 631-635 ◽

Cited By ~ 16

Author(s):

Thomas J. Lovely ◽

Allen Carl

Keyword(s):

Cervical Spine ◽

Early Mobilization ◽

Fusion Rate ◽

Spine Fusion ◽

Tension Band ◽

Tension Band Wiring ◽

Content Type ◽

Subaxial Cervical Spine ◽

Cervical Spine Fusion ◽

Fine Print

✓ In this study the authors detail their experience with posterior tension-band wiring for stabilization of the subaxial cervical spine. Fifty-five patients underwent fusion for trauma (41 patients), degenerative disease (13 patients), and tumor (one patient). The fusion rate was 96% (50 of 52 patients) and postoperative immobilization was accomplished by means of a Philadelphia collar in the majority of cases. Tension-band wiring provides a stable construct that is simple to perform, requires fusion of a minium number of motion segments, and allows early mobilization with only a hard collar needed for support. The details of the technique, which has been modified from preliminary descriptions, are discussed.

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Use of recombinant human bone morphogenetic protein for revision cervical spine fusion in children with Down syndrome: a case series

Journal of Neurosurgery Pediatrics ◽

10.3171/2019.11.peds19622 ◽

2020 ◽

Vol 25 (5) ◽

pp. 535-539

Author(s):

Lara L. Cohen ◽

Brian W. Yang ◽

Nora P. O’Neill ◽

Mark R. Proctor ◽

Michael P. Glotzbecker ◽

...

Keyword(s):

Down Syndrome ◽

Cervical Spine ◽

Postoperative Complications ◽

Case Series ◽

Spine Fusion ◽

Morphogenetic Protein ◽

Human Bone Morphogenetic Protein ◽

Cervical Spine Fusion ◽

Recombinant Human Bone

OBJECTIVEPatients with trisomy 21 (Down syndrome; DS) often have atlantoaxial instability (AAI), which, if severe, causes myelopathy and neurological deterioration. Children with DS and AAI who undergo cervical spine fusion have a high rate of nonunion requiring revision surgery. Recombinant human bone morphogenetic protein–2 (rhBMP-2) is a TGF-β growth factor that is used to induce bone formation in spine fusion. Although previous studies in the adult population have reported no reduction in pseudarthrosis rates with the use of rhBMP-2, there is a lack of literature in the pediatric DS population. This study describes the use of rhBMP-2 in children with DS and AAI during revision to treat nonunion.METHODSA retrospective review of a cervical spine fusion database (n = 175) was conducted. This database included all cervical spine fusions using modern instrumentation at the authors’ institution from 2002 to 2019. Patients with DS who underwent a revision utilizing rhBMP-2 were included in the study. The number of prior fusions, use of rhBMP-2 in fusions, length of stay, halo use, and surgical data were collected. Postoperative complications and length of follow-up were also recorded.RESULTSEight patients (75% female) met the inclusion criteria. The average age at revision with rhBMP-2 was 11 years (range 3–19 years). All patients were diagnosed with nonunion after an initial cervical fusion. All revisions were posterior fusions of C1–2 (n = 2) or occiput to cervical (n = 6). All revisions included implant revisions, iliac crest bone grafting, and rhBMP-2 use. One patient required irrigation and debridement of an rhBMP-induced seroma. Another patient required return to the operating room to repair a dural tear. There were no neurological, infectious, airway, or implant-related complications. Revision utilizing rhBMP-2 achieved fusion in 100% (n = 8) of patients. The average length of follow-up was 42.6 months. All patients demonstrated solid fusion mass on the last radiograph.CONCLUSIONSThis is the first case series reporting the successful use of rhBMP-2 to facilitate cervical spine fusion in patients with DS after previous nonunion. In addition, few rhBMP-2–related postoperative complications occurred.

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