Presentations

Retrospective Analysis of Mesenchymal Stem Cell Allograft in Integrated Interbody Cervical Devices for One or More Level ACDF Procedures, Western Neurosurgical Society, Banff, Canada, September 2017.

Amir Vokshoor, MD, Institute of Neuro Innovation,  Johny Tran BA Molecular Cell & Biology, and Hannah Wroblewski, BA Physics

INTRODUCTION

Anterior cervical discectomy and fusion (ACDF) is currently the most common treatment modality for cervical degenerative disc disease. More than half a million bone grafts are used for spine fusion procedures in the United States each year.1 Bone grafts for spinal fusion surgery require three essential characteristics – osteoinductive growth factors to signal healing via osteoblastic differentiation of progenitor cells, osteogenic cells for new bone formation, and osteoconduction for bone scaffolding.2,3,4,5. Osteobiologic bone grafts vary greatly, thus, understanding the efficacy of various osteobiologics in healing distinct spinal regions is important to find the most effective and optimal care treatment.2 This study aims to elucidate the efficacy of successful bone fusion and clinical outcome for patients who underwent one or more level ACDF procedures using allograft with PEEK interbody cages and/or plate fixation.

MATERIALS/METHODS

This study is a retrospective chart analysis and radiographic review of patients from January 2014 to December 2015 who underwent one or more level ACDF procedures with plate fixation and/or stand-alone PEEK spacers using mesenchymal stem cell allograft. The research team collected the basic personal health information (PHI), consisting of the patient name, date of birth, and date of surgery, of eligible patients to identify suitable cases. Radiographic follow-up included computerized tomography (CT) scans and X-ray images at between 6 and 12 months. Outcomes were measured on BSF - Brantigen Steffee Fraser levels 1, 2, and 3. BSF 3 indicates a successful fusion defined as bone bridging at least half the fusion area with at least the density originally achieved at surgery.6 Analyses were performed with chi-squared test, and a p-value < .05 was considered statistically significant.

RESULTS

Overall fusion rate with either osteobiologic was 92.1 percent: Cellentra with 94.7 percent and Osteocel with 90 percent. There was no significant difference in fusion rates for the Osteocel and Cellentra group measured between 6 and 12 months (p=.316). Average age for Osteocel group was 62.7 and for Cellentra 68.3 years to date of surgery. T-tests were performed to test for differences in age between the two groups and no significant difference was found.

CONCLUSION

To our knowledge, our study is the first published to compare the efficacy of two different osteobiologics in ACDF surgery: Cellentra and Osteocel. Our fusion for Osteocel was similar to that mentioned in the literature (87.7%).7 Fusion rates from literature for Cellentra were not available. The fusion rates were both effective with Cellentra showing a slight nonsignificant advantage over Osteocel. There was no significant difference in fusion rates for the Osteocel and Cellentra group which were both comparable if not more effective options to the autograft gold standard. It is interesting that Cellentra shows equivalent if not preferable results to Osteocel, given that Osteocel is marketed as having 12x the total cellular concentration as Cellentra.8