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European Spine Journal

, Volume 12, Issue 4, pp 400–407 | Cite as

Do autologous growth factors enhance transforaminal lumbar interbody fusion?

  • Hwan T. Hee
  • Mohammad E. Majd
  • Richard T. Holt
  • Leann Myers
Original Article

Abstract

Pseudarthrosis remains a significant problem in spinal fusion. The objective of our study was to investigate the effects of autologous growth factors (AGF) in instrumented transforaminal lumbar interbody spinal fusion (TLIF). A prospective review was carried out of 23 patients who underwent TLIF with application of AGF, with a minimum 2-year follow-up. Comparison with our historical cohort (without AGF application) was performed. Mean age at surgery was 44.3 years in the AGF treatment group. Twelve had a positive smoking history. Fourteen had undergone previous spinal surgeries. Thirteen received one-level fusions and ten received two-level fusions. The radiographic results showed a fusion rate of 100% in one-level fusions and 90% in two-level fusions. There was no significant difference in pseudarthrosis rates between the AGF treatment group and historical cohort. Excluding the cases with pseudarthrosis, there was faster bony healing in patients who had been treated with AGF application. This study indicates that although AGF may demonstrate faster fusions, it does not result in an overall increase in spinal fusion rates. Further studies are needed before AGF can routinely be used as an adjunct in spinal fusion.

Keywords

Autologous growth factors (AGF) Platelet derived growth factor (PDGF) Pseudarthrosis Transforaminal lumbar interbody fusion (TLIF) Transforming growth factor-beta (TGF-β) 

References

  1. 1.
    An HS, Lynch K, Toth J (1995) Prospective comparison of autograft vs allograft for adult posterolateral lumbar spine fusion: differences among freeze-dried, frozen, and mixed grafts. J Spinal Disord 8:131–135PubMedGoogle Scholar
  2. 2.
    Arm DM (2000) A comparison of autologous growth factors (AGFTM) and platelet gel. Presented at the 16th International Symposium—Bone growth Factors and Substitutes, CoronadoGoogle Scholar
  3. 3.
    Arm DM, Lowery GL, Hood AG, Shors EC (1999) Characterization of an autologous platelet gel containing multiple growth factors. Presented at the 45th Orthopaedic Research Society Meeting, AnaheimGoogle Scholar
  4. 4.
    Arm DM, Ponticiello M, Shors EC (2001) Autologous growth factors: characterization and clinical use. J Bone Joint Surg Br 83 [Suppl III]:366Google Scholar
  5. 5.
    Boden SD, Zdeblick TA, Sandhu HS, Heim SE (2000) The use of rhBMP-2 in interbody fusion cages. Definitive evidence of osteoinduction in humans: a preliminary report. Spine 25:376–381CrossRefPubMedGoogle Scholar
  6. 6.
    Bostrom MP, Camacho NP (1998) Potential role of bone morphogenetic proteins in fracture healing. Clin Orthop 355 [Suppl]:274–282Google Scholar
  7. 7.
    Buckwalter JA, Cruess RL (1991) Healing of the musculoskeletal tissues. In: Rockwood CA, Green DP (eds) Fractures in adults. JB Lippincott, Philadelphia, pp 181–222Google Scholar
  8. 8.
    Buckwalter JA, Glimcher MJ, Cooper RR, Recker R (1995) Bone biology. II. Formation, form, modeling, remodeling, regulation of cell function. J Bone Joint Surg Am 77:1276–1289Google Scholar
  9. 9.
    Canalis E (1985) Effect of growth factors on bone cell replication and differentiation. Clin Orthop 193:246–263PubMedGoogle Scholar
  10. 10.
    Canalis E, McCarthy TL, Centrella M (1989) Effects of platelet derived growth factor on bone formation in vitro. J Cell Physiol 140:530–537PubMedGoogle Scholar
  11. 11.
    Caplan AI (1991) Mesenchymal stem cells. J Orthop Res 9:641–650PubMedGoogle Scholar
  12. 12.
    Centrella M (1989) Platelet-derived growth factor enhances deoxyribonucleic acid and collagen synthesis in osteoblast-enriched cultures from fetal rat parietal bone. Endocrinology 125:13–19PubMedGoogle Scholar
  13. 13.
    Curylo LJ, Johnstone B, Petersilge CA, Janicki JA, Yoo JU (1999) Augmentation of spinal arthrodesis with autologous bone marrow in a rabbit posterolateral spine fusion model. Spine 24:434–439CrossRefPubMedGoogle Scholar
  14. 14.
    De Palma AF (1968) The nature of pseudoarthrosis. Clin Orthop 59:113–118PubMedGoogle Scholar
  15. 15.
    Eie N, Solgaard T, Kleppe H (1983) The knee-elbow position in lumbar disc surgery: a review of complications. Spine 8:897–900PubMedGoogle Scholar
  16. 16.
    Fujimaki A, Crock HV, Bedbrook GM (1982) The results of 150 anterior lumbar interbody fusion operations performed by two surgeons in Australia. Clin Orthop 165:164–167PubMedGoogle Scholar
  17. 17.
    Gertzbein SD, Betz R, Clements D, Errico T, Hammerberg K, Robbins S, Shepherd E, Weber A, Kerina M, Albin J, Wolk D, Ensor K (1996) Semirigid instrumentation in the management of lumbar spinal conditions combined with circumferential fusion. A multicenter study. Spine 21:1918–1926CrossRefPubMedGoogle Scholar
  18. 18.
    Gospodarowicz D (1983) Growth factors and their action in vivo and in vitro. J Pathol 141:201–233PubMedGoogle Scholar
  19. 19.
    Hee HT, Castro FP, Majd ME, Holt RT, Myers L (2001) Anterior/posterior lumbar fusion versus transforaminal lumbar interbody fusion: analysis of complications and predictive factors. J Spinal Disord 14:533–540CrossRefPubMedGoogle Scholar
  20. 20.
    Howes R, Bowness JM, Grotendorst GR, Martin GR, Reddi AH (1988) Platelet derived growth factor enhances demineralized bone matrix induced cartilage and bone formation. Calcif Tissue Int 42:34–38PubMedGoogle Scholar
  21. 21.
    Joyce ME, Jingushi S, Scully SP, Bolander ME (1991) Role of growth factors in fracture healing. Prog Clin Biol Res 365:391–416PubMedGoogle Scholar
  22. 22.
    Kasperk CH, Wergedal JE, Mohan S, Long DL, Lau KH, Baylink DJ (1990) Interactions of growth factors present in bone matrix with bone cells: effects on DNA synthesis and alkaline phosphatase. Growth Factors 3:147–158PubMedGoogle Scholar
  23. 23.
    Kozak JA, O'Brien JP (1990) Simultaneous combined anterior and posterior fusion. An independent analysis of a treatment of the disabled low-back pain patient. Spine 15:322–328Google Scholar
  24. 24.
    Lane JM (2001) BMPs: why are they not in everyday use? J Bone Joint Surg Am 83 [Suppl 1]:161–163Google Scholar
  25. 25.
    Lane JM, Tomin E, Bostrom MP (1999) Biosynthetic bone grafting. Clin Orthop 367 [Suppl]:107–117Google Scholar
  26. 26.
    Lin P, Cautilli R, Joyce M (1983) Posterior lumbar interbody fusion. Clin Orthop 180:154–167PubMedGoogle Scholar
  27. 27.
    Lindholm TS, Ragni P, Lindholm TC (1988) Response of bone marrow stroma cells to dimineralized cortical bone matrix in experimental spinal fusion in rabbits. Clin Orthop 230:296–302PubMedGoogle Scholar
  28. 28.
    Lowe TG, Tahernia AD, O'Brien MF, Smith DAB (2002) Unilateral transforaminal posterior lumbar interbody fusion (TLIF): indications, technique, and 2-year results. J Spinal Disord Tech 15:31–38PubMedGoogle Scholar
  29. 29.
    Lowery GL, Kulkarni S, Pennisi AE (1999) Use of autologous growth factors in lumbar spinal fusion. Bone [Suppl] 25:47–50Google Scholar
  30. 30.
    Marx RE, Carlson ER, Eichstaedt RM, Schimmele SR, Strauss JE, Georgeff KR (1998) Platelet-rich plasma. Growth factor enhancement for bone grafts. Oral Surg Oral Med Oral Pathol 85:638-646PubMedGoogle Scholar
  31. 31.
    Nather A, Hee HT (2002) New frontiers in spinal surgery. In: Nather A (ed) Research methodology in orthopaedics and reconstructive surgery. World Scientific, New Jersey, pp 551–574Google Scholar
  32. 32.
    Nimni ME (1997) Polypeptide growth factors: targeted delivery systems. Biomaterials 18:1201–1225CrossRefPubMedGoogle Scholar
  33. 33.
    Noda M (1998) In vivo stimulation of bone formation by transforming growth factor-β. Endocrinology 124:2991–2994Google Scholar
  34. 34.
    Pfeilschifter J (1990) Stimulation of bone matrix apposition in vitro by local growth factors: a comparison between insulin-like growth factor I, platelet-derived growth factor, and transforming growth factor-β. Endocrinology 127:69–75PubMedGoogle Scholar
  35. 35.
    Scott-Young M (2001) Spinal fusion using autologous growth factor. J Bone Joint Surg Br 83 [Suppl III]:366Google Scholar
  36. 36.
    Seppa H, Grotendorst G, Seppa S, Schiffmann E, Martin GR (1982) Platelet-derived growth factor is chemotactic for fibroblasts. J Cell Biol 92:584–588PubMedGoogle Scholar
  37. 37.
    Slater M, Patava J, Kingham K, Mason RS (1995) Involvement of platelets in stimulating osteogenic activity. J Orthop Res 13:655–663PubMedGoogle Scholar
  38. 38.
    Tullberg T, Brandt B, Rydberg J, Fritzell P (1996) Fusion rate after posterior lumbar interbody fusion with carbon fiber implant: 1-year follow-up of 51 patients. Eur Spine J 5:178–182PubMedGoogle Scholar
  39. 39.
    Vaccaro AR, Ball ST (2000) Indications for instrumentation in degenerative lumbar spinal disorders. Orthopedics 23:260–271PubMedGoogle Scholar
  40. 40.
    Vaccaro AR, Chiba K, Heller JG, Patel TC, Thalgott JS, Truumees E, Fischgrund JS, Craig MR, Berta SC, Wang JC (2002) Bone grafting alternatives in spinal surgery. Spine J 2:206–215CrossRefGoogle Scholar
  41. 41.
    Walsh WR, Loefler A, Nicklin S, Arm D, Yu Y (2001) Autologous growth factors for use in spinal fusion. J Bone Joint Surg Br 83 [Suppl III]:366–367Google Scholar
  42. 42.
    Yashiro K, Homma T, Hokari Y, Katsumi Y, Okumura H, Hirano A (1991) The Steffee variable screw placement system using different methods of bone grafting. Spine 16:1329–1334PubMedGoogle Scholar
  43. 43.
    Zdeblick TA (1993) A prospective randomized study of lumbar fusion. Preliminary results. Spine 18:983–991PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • Hwan T. Hee
    • 1
    • 2
    • 3
    • 4
  • Mohammad E. Majd
    • 1
  • Richard T. Holt
    • 1
    • 2
    • 3
  • Leann Myers
    • 3
  1. 1.Spine Surgery PSCLouisvilleUSA
  2. 2.University Of KentuckyLexingtonUSA
  3. 3.Tulane University Medical CenterNew OrleansUSA
  4. 4.Division of Spinal Surgery, Department of Orthopaedic SurgeryNational University HospitalSingapore

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