Skip to main content

Advertisement

SpringerLink
Log in

Clinical and radiographic outcomes of concentrated bone marrow aspirate with allograft and demineralized bone matrix for posterolateral and interbody lumbar fusion in elderly patients

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

Cell-based therapies such as concentrated bone marrow aspirate (BMA) with allograft and demineralized bone matrix (DBM) have been developed as a potential alternative to iliac crest bone graft (ICBG) in spinal fusion. BMA contains mesenchymal stem cells (MSCs) and growth factors that confer osteogenic and osteoinductive potential to osteoconductive scaffolds like allograft and DBM. It is well established that there is an age-related decline in bone marrow MSC population and efficacy. This might be problematic in spine arthrodesis when utilizing BMA derived from elderly patients as a fusion aide. The goal of this study was to describe the outcomes of concentrated BMA with allograft and DBM in elderly patients undergoing posterolateral and interbody lumbar fusion.

Methods

Thirty-one patients, age 65 and older, with a minimum of 12 months follow-up underwent combined primary posterolateral and transforaminal lumbar interbody fusion. Radiographic fusion, complications, reoperation rates and clinical outcomes were assessed. Multiple logistic regression analysis was used to examine the effects of variables such as patient age, gender, smoking, osteoporosis, Charlson co-morbidity index score, single versus multilevel fusion, length of hospital stay, and length of follow-up time on fusion outcome.

Results

The overall rate of a solid fusion (i.e. the concomitant presence of solid posterolateral and interbody fusion in a patient) was 83.9 % (26/31). Specifically, radiographic evidence of a successful posterolateral fusion was 83.9 % (26/31) while the radiographic evidence of a successful interbody fusion was 96.8 % (30/31). Using logistic regression analysis, none of the variables of interest had an association with non-solid unions. One (3.2 %) patient developed a seroma and one (3.2 %) patient developed clinical pseudarthrosis. None of the patients developed hardware-related complications or graft donor site morbidities. Five (16.1 %) patients required reoperation. Excellent or good results were achieved in 83.9 % of patients.

Conclusions

Despite the concerns of reduced fusion potential in elderly patients, autologous concentrated BMA mixed with allograft and DBM in posterolateral and interbody fusions can achieve successful fusion rates with good clinical outcomes and low complication rates.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Okuda S, Oda T, Miyauchi A, Haku T, Yamamoto T, Iwasaki M (2006) Surgical outcomes of posterior lumbar interbody fusion in elderly patients. J Bone Joint Surg Am 88:2714–2720. doi:10.2106/JBJS.F.00186

    Article  PubMed  Google Scholar 

  2. Dimitriou R, Mataliotakis GI, Angoules AG, Kanakaris NK, Giannoudis PV (2011) Complications following autologous bone graft harvesting from the iliac crest and using the RIA: a systematic review. Injury 42(Suppl 2):S3–15. doi:10.1016/j.injury.2011.06.015

    Article  PubMed  Google Scholar 

  3. Khashan M, Inoue S, Berven SH (2013) Cell based therapies as compared to autologous bone grafts for spinal arthrodesis. Spine 38:1885–1891. doi:10.1097/BRS.0b013e3182a3d7dc

    Article  PubMed  Google Scholar 

  4. Marmotti A, de Girolamo L, Bonasia DE, Bruzzone M, Mattia S, Rossi R, Montaruli A, Dettoni F, Castoldi F, Peretti G (2014) Bone marrow derived stem cells in joint and bone diseases: a concise review. DOI, Int Orthop. doi:10.1007/s00264-014-2445-4

    Google Scholar 

  5. Owen M, Friedenstein AJ (1988) Stromal stem cells: marrow-derived osteogenic precursors. Ciba Found Symp 136:42–60

    CAS  PubMed  Google Scholar 

  6. Park JJ, Hershman SH, Kim YH (2013) Updates in the use of bone grafts in the lumbar spine. Bull Hosp Jt Dis (2013) 71:39–48

    Google Scholar 

  7. Muschler GF, Midura RJ (2002) Connective tissue progenitors: practical concepts for clinical applications. Clin Orthop Relat Res 395:66–80

    Article  PubMed  Google Scholar 

  8. Muschler GF, Boehm C, Easley K (1997) Aspiration to obtain osteoblast progenitor cells from human bone marrow: the influence of aspiration volume. J Bone Joint Surg Am 79:1699–1709

    CAS  PubMed  Google Scholar 

  9. Youssef JA WJ, Lieberman IH et al (2008) Osteoprogenitor-enriched allograft in lumbar spinal fusion: preliminary findings from a two-year prospective multi-center study. In: Paper presented at North American Spine Society 23rd annual meeting pre-course section on spine biologics and research: clinical usage in human papers, Toronto, ON

  10. Kadiyala S, Kraus K, Attawaia M et al (2003) Rapid bone regeneration in femoral defects by an autologous osteoprogenitor cell concentrate prepared using an intraoperative selective cell retention technique. In: Transactions of the 49th annual meeting of the Orthopaedic Research Society, New Orleans, LA

  11. Wang JC, Youssef JA, Lieberman IH, Brodke, DS, Haynesworth SE, Lauryssen C, Patel T (2003) Selective Cell retention technology for spinal fusion. In: International meeting on advanced spine techniques, Rome, Italy

  12. Muschler GF, Nitto H, Boehm CA, Easley KA (2001) Age- and gender-related changes in the cellularity of human bone marrow and the prevalence of osteoblastic progenitors. J Orthop Res 19:117–125. doi:10.1016/S0736-0266(00)00010-3

    Article  CAS  PubMed  Google Scholar 

  13. Bergman RJ, Gazit D, Kahn AJ, Gruber H, McDougall S, Hahn TJ (1996) Age-related changes in osteogenic stem cells in mice. J Bone Miner Res 11:568–577. doi:10.1002/jbmr.5650110504

    Article  CAS  PubMed  Google Scholar 

  14. Brockbank KG, Ploemacher RE, van Peer CM (1983) An in vitro analysis of murine hemopoietic fibroblastoid progenitors and fibroblastoid cell function during aging. Mech Ageing Dev 22:11–21

    Article  CAS  PubMed  Google Scholar 

  15. Roholl PJ, Blauw E, Zurcher C, Dormans JA, Theuns HM (1994) Evidence for a diminished maturation of preosteoblasts into osteoblasts during aging in rats: an ultrastructural analysis. J Bone Miner Res 9:355–366. doi:10.1002/jbmr.5650090310

    Article  CAS  PubMed  Google Scholar 

  16. Tsuji T, Hughes FJ, McCulloch CA, Melcher AH (1990) Effects of donor age on osteogenic cells of rat bone marrow in vitro. Mech Ageing Dev 51:121–132

    Article  CAS  PubMed  Google Scholar 

  17. Stolzing A, Jones E, McGonagle D, Scutt A (2008) Age-related changes in human bone marrow-derived mesenchymal stem cells: consequences for cell therapies. Mech Ageing Dev 129:163–173. doi:10.1016/j.mad.2007.12.002

    Article  CAS  PubMed  Google Scholar 

  18. Asumda FZ, Chase PB (2011) Age-related changes in rat bone-marrow mesenchymal stem cell plasticity. BMC cell Biol 12:44. doi:10.1186/1471-2121-12-44

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  19. Lee K, Goodman SB (2009) Cell therapy for secondary osteonecrosis of the femoral condyles using the Cellect DBM System: a preliminary report. J Arthroplast 24:43–48. doi:10.1016/j.arth.2008.01.133

    Article  CAS  Google Scholar 

  20. Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P, Januel JM, Sundararajan V (2011) Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol 173:676–682. doi:10.1093/aje/kwq433

    Article  PubMed  Google Scholar 

  21. Kepler CK, Rihn JA, Radcliff KE, Patel AA, Anderson DG, Vaccaro AR, Hilibrand AS, Albert TJ (2012) Restoration of lordosis and disk height after single-level transforaminal lumbar interbody fusion. Orthop Surg 4:15–20. doi:10.1111/j.1757-7861.2011.00165.x

    Article  PubMed  Google Scholar 

  22. Lenke LG, Bridwell KH, Bullis D, Betz RR, Baldus C, Schoenecker PL (1992) Results of in situ fusion for isthmic spondylolisthesis. J Spinal Disord 5:433–442

    Article  CAS  PubMed  Google Scholar 

  23. Brantigan JW, Steffee AD (1993) A carbon fiber implant to aid interbody lumbar fusion. Two-year clinical results in the first 26 patients. Spine 18:2106–2107

    Article  CAS  PubMed  Google Scholar 

  24. Lee DY, Jung TG, Lee SH (2008) Single-level instrumented mini-open transforaminal lumbar interbody fusion in elderly patients. J Neurosurg Spine 9:137–144. doi:10.3171/SPI/2008/9/8/137

    Article  PubMed  Google Scholar 

  25. Nandyala SV, Marquez-Lara A, Fineberg SJ, Pelton M, Singh K (2014) Prospective, randomized, controlled trial of silicate-substituted calcium phosphate versus rhBMP-2 in a minimally invasive transforaminal lumbar interbody fusion. Spine 39:185–191. doi:10.1097/BRS.0000000000000106

    Article  PubMed  Google Scholar 

  26. Thaler M, Lechner R, Gstottner M, Kobel C, Bach C (2013) The use of beta-tricalcium phosphate and bone marrow aspirate as a bone graft substitute in posterior lumbar interbody fusion. Eur Spine J 22:1173–1182. doi:10.1007/s00586-012-2541-3

    Article  PubMed Central  PubMed  Google Scholar 

  27. Carter JD, Swearingen AB, Chaput CD, Rahm MD (2009) Clinical and radiographic assessment of transforaminal lumbar interbody fusion using HEALOS collagen-hydroxyapatite sponge with autologous bone marrow aspirate. Spine J 9:434–438. doi:10.1016/j.spinee.2008.11.004

    Article  PubMed  Google Scholar 

  28. Johnson RG (2014) Bone marrow concentrate with allograft equivalent to autograft in lumbar fusions. Spine 39:695–700. doi:10.1097/BRS.0000000000000254

    Article  PubMed  Google Scholar 

  29. Hustedt JW, Jegede KA, Badrinath R, Bohl DD, Blizzard DJ, Grauer JN (2013) Optimal aspiration volume of vertebral bone marrow for use in spinal fusion. Spine J 13:1217–1222. doi:10.1016/j.spinee.2013.07.435

    Article  PubMed  Google Scholar 

  30. Carreon LY, Puno RM, Dimar JR, Glassman SD, Johnson JR (2003) Perioperative complications of posterior lumbar decompression and arthrodesis in older adults. J Bone Joint Surg Am 85-A:2089–2092

  31. Andersen T, Christensen FB, Niedermann B, Helmig P, Hoy K, Hansen ES, Bunger C (2009) Impact of instrumentation in lumbar spinal fusion in elderly patients: 71 patients followed for 2–7 years. Acta orthopaedica 80:445–450. doi:10.3109/17453670903170505

    Article  PubMed Central  PubMed  Google Scholar 

  32. Fischgrund JS, Mackay M, Herkowitz HN, Brower R, Montgomery DM, Kurz LT (1997) 1997 Volvo Award winner in clinical studies. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation. Spine 22:2807–2812

    Article  CAS  PubMed  Google Scholar 

  33. Hu SS (1997) Internal fixation in the osteoporotic spine. Spine 22:43S–48S

    Article  CAS  PubMed  Google Scholar 

  34. Okuyama K, Abe E, Suzuki T, Tamura Y, Chiba M, Sato K (2001) Influence of bone mineral density on pedicle screw fixation: a study of pedicle screw fixation augmenting posterior lumbar interbody fusion in elderly patients. Spine J 1:402–407

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

No funds were received in support of this work.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, UCLA Medical Center, 1250 16th Street, Suite 3142, Santa Monica, CA, 90404, USA

    Remi M. Ajiboye, Jason T. Hamamoto & Mark A. Eckardt

  2. Department of Orthopaedic Surgery, Keck Medicine of USC, 1200 N. State Street, GNH 3900, Los Angeles, CA, 90033, USA

    Jeffrey C. Wang

Authors
  1. Remi M. Ajiboye
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jason T. Hamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mark A. Eckardt
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jeffrey C. Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Remi M. Ajiboye.

Ethics declarations

Conflict of interest

No relevant financial disclosures are associated with this work.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ajiboye, R.M., Hamamoto, J.T., Eckardt, M.A. et al. Clinical and radiographic outcomes of concentrated bone marrow aspirate with allograft and demineralized bone matrix for posterolateral and interbody lumbar fusion in elderly patients. Eur Spine J 24, 2567–2572 (2015). https://doi.org/10.1007/s00586-015-4117-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-015-4117-5

Keywords

Search

Navigation