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Presenter: Richard Hostin ( a,d ) DePuy Spine; (e) Axial Biotech

E-Poster #510 Mineralized Collagen and Bone Marrow Aspirate in Anterior Interbody Carbon Fiber Cages Achieve High Fusion Rates in Multilevel Adult Spinal Deformity. Richard Hostin, M.D.; Eric Klineberg, M.D.; Shay Bess, M.D.; Munish Gupta, M.D.; International Spine Study Group.

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Presenter: Richard Hostin ( a,d ) DePuy Spine; (e) Axial Biotech

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  1. E-Poster #510 Mineralized Collagen and Bone Marrow Aspirate in Anterior Interbody Carbon Fiber Cages Achieve High Fusion Rates in Multilevel Adult Spinal Deformity Richard Hostin, M.D.; EricKlineberg, M.D.; Shay Bess, M.D.; Munish Gupta, M.D.; International Spine Study Group

  2. E-Poster #510 Mineralized collagen and bone marrow. . . Presenter: Richard Hostin (a,d) DePuy Spine; (e) Axial Biotech Co-Authors: Eric Klineberg (a) OREF; (b) Synthes; (d) DePuy Spine, Stryker, Synthes (e) AO Shay Bess (a,b) DePuy Spine; (b) Allosource; (c) Pioneer Munish Gupta (b) DePuy Spine, Osteotech, Lanx; (c) DePuy Spine, J&J, Pioneer, Proctor & Gamble, Acrotech, Pfizer; (d) AO, Medtronic International Spine Study Group (a) DePuy Spine • Grants/Research Support • Consultant • Stock/Shareholder • Speakers’ Bureau • Other Financial Support 18th International Meeting on Advanced Spine Techniques Authors Disclosure Information

  3. Summary • Single-center, blinded radiographic and patient outcome analysis of multilevel anterior spine fusion rates using bone marrow aspirate and mineralized collagen in anterior interbody fusion cages in adult spinal deformity patients. • Fusion grades based on published Lenke-Bridwell grading scale • 1 – Complete fusion • 2 – Probable fusion with no lucencies • 3 – an intact graft with lucency at the top or bottom of the graft • 4 – nonunion with resorption of the graft

  4. Introduction • Many factors can affect success of spine fusion • Patient co-morbidities • Position of implant • Mechanical and/or biological deficiencies • Debate continues regarding the “proper” method of assessing union with bone graft replacements as well as the cost vs benefit of available osteobiologics

  5. Introduction • Surgical exploration and radiographic analysis continue to be acceptable options for evaluating fusion success • Purpose:To determine the ability of bone marrow aspirate and mineralized collagen placed in carbon fiber polymer cages to achieve multilevel anterior fusion in adult spinal deformity patients.

  6. Methods • Prospective, consecutive, adult spinal deformity patients who required long fusions to the pelvis underwent multilevel anterior spine fusion using bone marrow aspirate/mineralized collagen and a carbon fiber interbody device, combined with instrumented posterior spinal fusion • Radiographic analysis included preop and minimum 1 year postop full length coronal and sagittal radiographs, lumbar flexion/extension radiographs and postop lumbar CT scans

  7. Methods • Anterior spine fusion status at each level (T11-S1) evaluated minimum 1 year postoperatively by 3 independent surgeons using the Bridwell-Lenke grading scale • Grades <2.5 classified as fused • Grades >2.5 classified as not fused • Pre and post op HRQOL measures included: VAS, SRS-22, and ODI

  8. Methods Statistical analysis: Comparison analysis using paired t-tests was performed with minimum of 1 year follow up Changes in ODI scores from preoperative to 1 year postop decreased significantly by an average of 12.53 (p=0.02) Changes in ODI scores from preop to 2 year post op decreased significantly by an average of 10.80 (p=0.02) There was no statistical change in ODI scores between the two post op periods (year 1 to year 2) Similar results were observed for SRS and VAS scores

  9. Results • From 2006-2008, 23 adult spinal deformity patients received 109 anterior spine fusions (mean 4.7 levels/patient) • Follow up = 1.6 years • 95% of levels were classified as fused on plain radiographs • 86% of levels classified as fused on CT • Improvement demonstrated for all HRQOL measures • No statistically significant differences in outcome measures between patients classified as fused versus non-fused

  10. Results

  11. Conclusion • Bone marrow aspirate/mineralized collagen demonstrates high fusion rates and improved patient outcomes for multilevel anterior spine fusions at intermediate follow-up. • Bone marrow aspirate/mineralized collagen is a viable osteobiologic alternative for anterior spine fusion in adult spine deformity patients receiving combined anterior and posterior spinal fusion.

  12. References • Bridwell and Lenke et al., Spine, 20: 1410-1418, 1995 • Mulconrey and Lenke et al., Spine, 33: 2153-2159, 2008 • Eck and Lenke et al., J Spin Disord, 13: 501-509, 2000 • Tan et al., Eur Spine J, 16:1875-1881, 2007 • Shah RR and Taylor, Eur Spine J, 12: 378-385, 2003 • Neen et al., Spine, 31: E636-E640, 2006 • Tay et al., Spine, 23: 2276-2281, 1998 • Zdeblick, Spine, 18: 983-991, 1993 • Brantigan and Steffee, Spine, 18: 2106-2117, 1992 • Akbarnia et al., Orthopedic Transactions, 17: 123, 1993

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