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Outcomes of Demineralized Bone Matrix Enriched with Concentrated Bone Marrow Aspirate in Lumbar Fusion

Remi M. Ajiboye MD,1 Mark A. Eckardt BA,1 Jason T. Hamamoto BS,1 Benjamin Plotkin MD,1 Michael D. Daubs MD,2 Jeffrey C. Wang MD3

1UCLA Medical Center, Department of Orthopaedic Surgery, Santa Monica, CA  2University of Nevada School of Medicine, Department of Orthopaedic Surgery,  Las Vegas, NV 3Keck Medicine of USC, Department of Orthopaedic Surgery,  Los Angeles, CA

Abstract

Background

Multiple studies have demonstrated that a significant amount of variability exists in various demineralized bone matrix (DBM) formulations, which casts doubts on its reliability in consistently promoting fusion. Bone marrow aspirate (BMA) is a cellular based graft that contains mesenchymal stem cells (MSCs) and growth factors can confer osteogenic and osteoinductive potential to DBM. The goal of this study was to describe the outcome of DBM enriched with concentrated BMA in patients undergoing combined lumbar interbody and posterolateral fusion.

Methods

Eighty patients with a minimum of 12 months of follow-up were evaluated. Fusion and rates of complication were evaluated. Functional outcomes were assessed based on the modified Odom’s criteria. Multiple logistic regression analysis was used to examine the effects of independent variables on fusion outcome.

Results

The overall rate of solid fusion (i.e patients with both solid posterolateral and interbody fusion) was 81.3% (65/80). Specifically, the radiographic evidence of solid posterolateral and interbody fusions were 81.3% (65/80) and 92.5% (74/80), respectively. Seven (8.75%) patients developed hardware-related complications, 2 (2.5%) patients developed a postoperative infection and 2 (2.5%) patients developed clinical pseudarthrosis. Charlson comorbidity index (CCI) scores of 3 and 4 were associated with non-solid unions (CCI-3, p = 0.048; CCI-4, p = 0.03). Excellent or good outcomes were achieved in 58 (72.5%) patients.

Conclusions

Patients undergoing lumbar fusion using an enriched bone graft containing concentrated BMA added to DBM can achieve successful fusion with relatively low complications and good functional outcomes. Despite these findings, more studies with higher level of evidence are needed to better understand the efficacy of this promising graft option.

keywords: 
Lumbar fusion; Demineralized bone matrix; Bone marrow aspirate
Volume 10 Article 35
doi: 
10.14444/3035