Transforaminal Lumbar Interbody Fusion With Viable Allograft: 75 Consecutive Cases at 12-Month Follow-up

Abstract

Background: When conservative treatments fail to alleviate the discomfort of abnormal motion, spinal fusion has been shown to provide symptomatic treatment for spinal instability, stenosis, spondylolisthesis, and symptomatic degenerative disc disease. The trend and rates of fusion over the past few years have been dramatic in the United States. Accompanying that higher incidence has been the shifting from traditional open surgery to minimally invasive techniques to reduce scar tissue formation, extent of muscle stripping, and muscle retraction which all have been shown to adversely affect outcomes. Other reasons supporting the widespread transition to minimally invasive surgical (MIS) techniques include decreased postoperative pain, decreased intraoperative blood loss, shorter postoperative hospital stay, faster return to normal activity, and reduced reoperation rates. Spinal fusion procedures rely on a bony fusion substrate in addition to fixation hardware. While available grafting options include autogenous, allogeneic, and synthetic materials, recent interest in viable allograft material with living cells has drawn attention and attraction for incorporating a biologic basis for regenerative consideration. A recent viable allograft, complete with cellular and designated bone carrier (VIA Graft, Vivex Biomedical, Marietta, Georgia) has been developed. This study represents a retrospective review of a single-practice, single-surgeon evaluation of the product in 75 consecutive patients for fusion by computed tomography (CT) and radiographic evaluation at 12 months in conjunction with a MIS approach. Viable allograft was used to fill the peri-implant space, and central implant lumen was filled with a cancellous bone sponge soaked in perivertebral bone marrow. Posterolateral supplementation was attained with beta-tricalcium phosphate as a bulking agent.Methods: A retrospective review identified patients treated for both primary and revision surgery who received VIA Graft cellular bone matrix material in minimally invasive interbody fusion (MIS-TLIF) with a minimum of 12month follow up. The patient diagnoses included radiculopathy in all instances and varied collateral indications such as foraminal collapse, recurrent disc herniation, and spondylolisthesis to which pain and morbidity had been unresolved by conservative treatment. Adverse events including infection, revisions, and evidence of immune response were evaluated and patient comorbidities defined for the entire population of patients. Patient fusion status was assessed using thin slice CT by 2 independent radiologists separate from the surgeon. There were 75 consecutive adult patients with degenerative conditions of the lumbar spine who underwent MIS-TLIF surgery of which 40 (53%) were male and 35 (47%) were female. Mean age, height, and weight were 58 years, 170.18 cm (67 in), and 88.45 kg (195 lbs), respectively. The mean body mass index was 30. There were 16 patients (21%) who smoked and 12 (16%) with a history of diabetes. Independent blinded review of f...

Human Bone Marrow-Derived Mesenchymal Stromal Cell-Seeded Bone Biomaterial Directs Fast and Superior Mandibular Bone Augmentation in Rats

“…In this study, we showed that a cell-seeded bone biomaterial is capable of consistently and successfully augmenting the mandibular bone, while presenting histological features of healthy living bone. Bone biomaterials have been safely used in the field of Orthopaedics surgery in the past 40 years 28 , and the new generation of viable bone biomaterial we tested in this study is currently being used for applications such as spine fusion with great success 26 . In addition, the remodeling of this cell-seeded bone biomaterial was more rapid and led to a larger bone formation compared to the acellular biomaterial used as a control.…”

“…The attempts of improving bone grafts using MSCs have shown good preliminary outcomes evidenced by clear differences between the enriched grafts and the non-cellularized grafts 23–25 . Our group developed a cellularized bone substitute material which is currently available on the US market for spine fusion applications (ViaGraft ® , Vivex Biomedical, Miami, FL) 26 . This material is made of cadaveric human bone microparticles (30% cortical bone, 30% cancellous bone and 40% fully demineralized cortical bone) ranging from 100–300 microns in size and seeded with MSCs (see supplementary Fig.…”

Methods of Cryoprotectant Preservation: Allogeneic Cellular Bone Grafts and Potential Effects

“…Clinical challenges concomitant to tissue loss have benefitted from viable allograft in surgical fusions [43]. Moreover, with low complications, high regenerative potential, and economic value in reduced time to healing, higher rate of fusion, and shorter windows of recovery, advances in cryoprotectant technology will continue to improve.…”

Understanding the Future Prospects of Synergizing Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgery with Ceramics and Regenerative Cellular Therapies

“…Following the MIS-TLIF procedure, improvement in the interbody fusion rate minimizes hospitalization time, efficacy, and safety. Fusion is also impacted by bone materials (autograft/allograft or synthetic), cage size [ 32 ], osteoinductive molecules, viable cells, and regenerative materials [ 33 ]. On the contrary, meta-analysis has also reported that irrespective of the graft material, the fusion rate in MIS-TLIF is very high [ 34 ].…”

“…Autografts derived from iliac crest are rich in live cells, osteoinductive growth factors, and channels necessary for vascularization, which could promote effective lumbar fusion [ 95 ]. A retrospective study with 75 consecutive cases showed that iliac crest bone graft (ICBG) could effectively aid in achieving a higher rate of spinal fusion without any major perioperative or latent complications and transfusion [ 33 ]. Furthermore, no significant difference in postoperative pain/disability and blood loss was found between BMP-2 and ICBG-treated patients.…”