M.Yu. Sizikov
A.A. Ostanin
M.V. Kheifets
E.R.Chernykh |
ANTERIOR FUSION FOR COMPLICATED SPINE INJURY WITH
APPLICATION OF DIRECTED OSTEOINDUCTION THROUGH AUTOGRAFTING OF IMMOBILIZED
BONE-MARROW STROMAL STEM CELLS |
Novosibirsk Research Institute of Traumatology and
Orthopaedics, Novosibirsk, Russia
Research Institute of Clinical Immunology SB RAMS, Novosibirsk, Russia
|
Local and systemic disorders in osteopoietic function in patients with complicated
injury of the spine require the application of osteoplastic material with enhanced
osteoinductive and bioplastic properties. Objective. The objective of the study
was to develop a method of local restoration of the function of reparative osteogenesis
disturbed in patients with complicated spine injury. Material and methods. The
study was performed in two groups of patients with complicated injury to the
thoracolumbar spine at the T7-L2 levels. Each group included 10 patients aged
between 25 and 57 years. Patients from the first (control) group underwent
subtotal resection of the injured vertebral body, anterior open decompression
of the spinal cord, corrective fusion with porous NiTi implant without application
of immobilized cells combined with osteoplasty. Patients from the second (study)
group underwent corrective fusion with porous NiTi implant in combination with
autografting of immobilized bone-marrow stromal stem cells. Immobilization of
stromal stem cells and their grafting were performed by proprietary method developed
in the experiment. Results were assessed at 1 month and consequently at 3, 6,
9, and 12 months after surgery by methods of clinical, radiological, densitometric,
computed X-ray tomography, and MRI examination. Results. At late follow-up the
signs of delayed anterior vertebral body consolidation with low bone density
following the pattern of indirect osteogenesis were detected in 8 patients from
the control group. Hypertrophic pseudoarthrosis developed in 2 patients, and
partial dislocation of the implant with loss of the achieved correction - in
4 patients. Regression of neurological deficit was partial and occurred
in 6 patients, no dynamics was observed in 3 patients, and 1 patients developed
deterioration which required repeated spinal cord decompression. All patients
from the study group presented with robust artificial anterior vertebral
block with normal bone density following the pattern of direct osteogenesis.
There were no signs of the implant dislocation or correction loss. A stable
positive neurological dynamics was observed in all cases with almost full regression
of neurological deficit in 3 patients. Conclusion. Autografting of immobilized
bone-marrow stromal stem cells combined with anterior fusion in patients with
complicated thoracolumbar spine injury allows accelerated (within 6-12 months)
completion of artificial bone block formation. Correction of the deformity
achieved during surgery is maintained without excessive heterogeneous ossification.
Stable fusion with a full integration of porous implant in cortical bone, and
formation of mature regenerated bone with normal density following a pattern
of direct osteogenesis are concurring with a stable positive neurological dynamics.
Suggested method can be used as a method of choice in the treatment of patients
with complicated spine injury.
