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Aspiration of Osteoprogenitor Cells for Augmenting Spinal Fusion: Comparison of Progenitor Cell Concentrations from the Vertebral Body and Iliac Crest
Robert F. McLain, MD1; James E. Fleming, MD1; Cynthia A. Boehm, BS1; George F. Muschler, MD1
1 Department of Orthopaedic Surgery, Desk A 41, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195. E-mail address for R.F. McLain: mclainr@ccf.org
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A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).
In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from National Institutes of Health AR42997, OREF. In addition, one or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (DePuy Spine, Inc.). No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Dec 01;87(12):2655-2661. doi: 10.2106/JBJS.E.00230
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Abstract

Background: Successful arthrodesis in challenging clinical scenarios is facilitated when the site is augmented with autograft bone. The iliac crest has long been the preferred source of autograft material, but graft harvest is associated with frequent complications and pain. Connective tissue progenitor cells aspirated from the iliac crest and concentrated with allograft matrix and demineralized bone matrix provide a promising alternative to traditional autograft harvest. The vertebral body, an even larger reservoir of myeloproliferative cells, should provide progenitor cell concentrations similar to those of the iliac crest.

Methods: Twenty-one adults (eleven men and ten women with a mean age of 59 ± 14 years) undergoing posterior lumbar arthrodesis and pedicle screw instrumentation underwent transpedicular aspiration of connective tissue progenitor cells. Aspirates were obtained from two depths within the vertebral body and were quantified relative to matched, bilateral aspirates from the iliac crest that were obtained from the same patient at the same time. Histochemical analysis was used to determine the prevalence of vertebral progenitor cells relative to the depth of aspiration, the vertebral level, age, and gender, as compared with the iliac crest standard. The cell count, progenitor cell concentration (cells/cc marrow), and progenitor cell prevalence (cells/million cells) were calculated.

Results: Aspirates of vertebral marrow demonstrated comparable or greater concentrations of progenitor cells compared with matched controls from the iliac crest. Progenitor cell concentrations were consistently higher than matched controls from the iliac crest (p = 0.05). The concentration of osteogenic progenitor cells was, on the average, 71% higher in the vertebral aspirates than in the paired iliac crest samples (p = 0.05). With the numbers available, there were no significant differences relative to vertebral body level, the side aspirated, the depth of aspiration, or gender. An age-related decline in cellularity was suggested for the iliac crest aspirates.

Conclusions: The vertebral body is a suitable site for aspiration of bone marrow for graft augmentation during spinal arthrodesis.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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    Panagiotis Korovessis, M.D., Ph.D.
    Posted on January 31, 2006
    Osteoprogenitor cell aspiration from vertberal body in posterior lumbar instrumented fusion
    General Hospital, "Agios Andreas", Patras, GREECE

    To The Editor:

    I have read with interest the above mentioned paper and I congratulate the authors.

    We recently published a study that compares the use of autograft and coralline hydroxyapatite in dorsal and lateral spine fusions (1). In this series we intraoperatively aspirated bone marrow containing myeloproliferative cells from the vertebral body (depth 40 and 45 mm) immediately before the insertion of the pedicle screws and mixed the marrow with coralline hydroxyapatite (Pro-Osteon 500R). However, during the study period, we did not count the cells. No iliac bone graft was taken in any patient who received the coralline hydroxyapatite/marrow mixture.

    All patients who received the mixture Pro- Osteon plus bone marrow had bony fusion within the first year following posterolateral instrumentation and fusion. The radiologic results of the bone marrow and Pro-Osteon group were comparable with a control group who had received iliac bone graft only. We agree with the conclusions derived from the study by McLain et al.

    Reference:

    (1) Korovessis P, Koureas G. Zacharatos S, Papazisis Z. Lambiris E. The correlative radiological, self-assessment and clinical analysis of evolution in instrumented dorsal and lateral fusion for degenerative lumbar spine disease. Autograft versus coralline hydroxyapatite. Eur Sp J. 2005; 14:630-38.

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