Mesenchymal stem cell allograft as a fusion adjunct in one- and two-level anterior cervical discectomy and fusion: a matched cohort analysis.
BACKGROUND
Live mesenchymal stem cell (MSC) allograft-containing allogeneic bone grafts have recently gained popularity and currently account for greater than 17% of all bone grafts and bone graft substitutes used in spinal surgery. Although the claim of cellular bone matrices containing osteogenic cells with osteoinductive properties is attractive, little is known about their clinical success when used in anterior cervical discectomy and fusion (ACDF).


OBJECTIVE
The objective of this study was to report on the radiographic fusion rates in one- and two-level instrumented ACDF using an MSC.


METHODS
This was a retrospective review of prospectively matched cohort of patients with radiologic assessment of fusion as the primary end point.


METHODS
Two matched cohorts of adult patients who underwent ACDF with MSC or standard allograft were included.


METHODS
The outcome measures included radiographic and clinical evidence of healing at 1 year.


METHODS
A consecutive series of 57 patients who underwent a one- or two-level instrumented ACDF procedure between 2010 and 2012 were retrospectively analyzed. All fusion constructs comprised an interbody allograft, an anterior plate, and Osteocel (NuVasive, San Diego, CA, USA). These patients were matched to a control group of 57 patients.


RESULTS
Of the 57 cases in both cohorts, 29 (50.9%) were single-level, and 28 (49.1%) were two-level instrumented ACDFs. There were no significant differences in patient age (p=.71), gender, comorbidity burden (Charlson Comorbidity Index [CCI]: 1.95; 2.42, p=.71) or body mass index (p=.79). At the 1-year follow-up, 50 of 57 (87.7%) patients in the Osteocel cohort demonstrated a solid fusion compared with 54 of 57 (94.7%) in the control group (p=.19). Seven (12.3%) patients in the Osteocel cohort were reported as having a failed fusion at 1 year.


CONCLUSIONS
This is the first non-industry sponsored study to analyze a matched cohort assessing the 1-year arthrodesis rates associated with a nonstructural MSC allograft in one- and two-level ACDF procedures. Although not statistically significant, patients treated with MSC allografts demonstrated lower fusion rates compared with a matched non-MSC cohort.
Department of Orthopaedic Surgery, Mount Sinai Medical Center, 5 E. 98th St, New York, NY 10029, USA.
Steven J
SJ
McAnany
Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St Suite 300, Chicago, IL 60612, USA.
Junyoung
J
Ahn
Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St Suite 300, Chicago, IL 60612, USA.
Islam M
IM
Elboghdady
Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St Suite 300, Chicago, IL 60612, USA.
Alejandro
A
Marquez-Lara
Department of Orthopaedic Surgery, Mount Sinai Medical Center, 5 E. 98th St, New York, NY 10029, USA.
Nomaan
N
Ashraf
Department of Orthopaedic Surgery, Mount Sinai Medical Center, 5 E. 98th St, New York, NY 10029, USA.
Branko
B
Svovrlj
Department of Orthopaedic Surgery, Mount Sinai Medical Center, 5 E. 98th St, New York, NY 10029, USA.
Samuel C
SC
Overley
Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St Suite 300, Chicago, IL 60612, USA.
Kern
K
Singh
Department of Orthopaedic Surgery, Mount Sinai Medical Center, 5 E. 98th St, New York, NY 10029, USA. Electronic address: sheerazqureshimd@gmail.com.
Sheeraz A
SA
Qureshi
D000328:Adult; D064591:Allografts; D001860:Bone Plates / Q000009:adverse effects; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D017586:Diskectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D045164:Mesenchymal Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D011859:Radiography; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*
Anterior cervical discectomy and fusion; Cellular bone matrices; Mesenchymal stem cell allograft; Pseudarthrosis; Radiological assessment of fusion; Structural allograft