Aspiration of osteoprogenitor cells for augmenting spinal fusion: comparison of progenitor cell concentrations from the vertebral body and iliac crest.
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.
McLain
Robert F
RF
Department of Orthopaedic Surgery, Desk A 41, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195. mclainr@ccf.org.
Fleming
James E
JE
Boehm
Cynthia A
CA
Muschler
George F
GF
D000368:Aged; D016025:Bone Transplantation; D002452:Cell Count; D005260:Female; D006801:Humans; D007085:Ilium / Q000166:cytology*; D008159:Lumbar Vertebrae / Q000166:cytology*; D008297:Male; D008875:Middle Aged; D013122:Spinal Diseases / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D033581:Stem Cell Transplantation / Q000379:methods*; D013234:Stem Cells; D013396:Suction / Q000379:methods; D014182:Transplantation, Autologous