Monash Immunology and Stem Cell Laboratories, Melbourne, Victoria, Australia.
Neurosurgery. 2011 Apr;68(4):1025-34; discussion 1034-5. doi: 10.1227/NEU.0b013e31820d5375.
Rapid, reliable fusion is the goal in anterior cervical diskectomy and fusion. Iliac crest autograft has a high rate of donor-site morbidity. Alternatives such as bone graft substitutes lack osteoinductivity, and recombinant bone morphogenetic proteins risk life-threatening complications. Both allogeneic mesenchymal precursor cells (MPCs) and amnion derived epithelial cells (AECs) have osteogenic potential.
To compare for the first time the capacity of MPCs and AECs to promote osteogenesis in an ovine model.
Five groups of 2-year-old ewes were subjected to C3-4 anterior cervical diskectomy and fusion with a Fidji interbody cage packed with iliac crest autograft alone (group A; n = 6), hydroxyapatite-tricalcium phosphate Mastergraft granules (HA/TCP) alone (group B; n = 6), HA/TCP containing 5 million MPCs (group C; n = 6), or HA/TCP containing 5 million AECs (group D; n = 5); group E was made up of age-matched nonoperative controls (n = 6). At 3 months, animals were euthanized and quantitative multislice computed tomography, functional radiography, biomechanics, histology, and histomorphometry were performed.
No procedure- or cell-related adverse events were observed. There was significantly more fusion in the MPC group (C) than in group A, B, or D. Computed tomography scan at 3 months revealed that 5 of 6 MPC-treated animals (83%) had continuous bony bridging compared with 0 of 5 AEC-treated and only 1 of 6 autograft- and 2 of 6 HA/TCP-treated animals (P = .01).
Implantation of allogeneic MPCs in combination with HA/TCP within an interbody spacer facilitates interbody fusion after diskectomy. The earlier, more robust fusion observed with MPCs relative to autograft and HA/TCP bone substitute indicates that this approach may offer a therapeutic benefit.
在前颈椎间盘切除和融合术中，快速可靠的融合是目标。髂嵴自体移植物有很高的供体部位发病率。替代物如骨移植替代物缺乏成骨诱导性，而重组骨形态发生蛋白则有危及生命的并发症风险。同种异体间充质前体细胞（MPCs）和羊膜衍生的上皮细胞（AECs）都具有成骨潜能。
首次比较 MPCs 和 AECs 在绵羊模型中促进成骨的能力。
将 5 组 2 岁的母羊进行 C3-4 前路颈椎间盘切除术和融合术，使用 Fidji 椎间笼，仅用髂嵴自体移植物填充（A 组；n = 6），单独使用羟基磷灰石-三钙磷酸盐 Mastergraft 颗粒（HA/TCP）（B 组；n = 6），HA/TCP 中含有 500 万个 MPCs（C 组；n = 6），或 HA/TCP 中含有 500 万个 AECs（D 组；n = 5）；E 组为年龄匹配的非手术对照组（n = 6）。在 3 个月时，对动物进行安乐死，并进行定量多层计算机断层扫描、功能放射学、生物力学、组织学和组织形态计量学检查。
未观察到与手术或细胞相关的不良事件。MPC 组（C）的融合明显多于 A、B 或 D 组。3 个月时的计算机断层扫描显示，6 只 MPC 治疗动物中有 5 只（83%）有连续的骨桥形成，而 5 只 AEC 治疗动物和仅 1 只自体移植物和 6 只 HA/TCP 治疗动物中没有（P =.01）。
在椎间间隙内植入同种异体 MPCs 联合 HA/TCP 可促进椎间盘切除术后的椎间融合。与自体移植物和 HA/TCP 骨替代物相比，MPC 更早、更稳健的融合表明，这种方法可能具有治疗益处。
