Ajiboye Remi M, Eckardt Mark A, Hamamoto Jason T, Sharma Akshay, Khan Adam Z, Wang Jeffrey C
Department of Orthopaedic Surgery, UCLA Medical Center, Santa Monica, CA.
Case Western Reserve School of Medicine, Cleveland, OH.
Clin Spine Surg. 2018 Feb;31(1):E30-E35. doi: 10.1097/BSD.0000000000000553.
Retrospective study.
Evaluate the effect of age on the efficacy of allograft/demineralized bone matrix (DBM) enriched with concentrated bone marrow aspirate (BMA) in posterolateral lumbar fusions (PLFs).
Cell-based therapies such as concentrated BMA have been developed as a potential alternative to iliac crest bone graft (ICBG). BMA contains mesenchymal stem cells (MSCs) and growth factors that can confer osteogenic and osteoinductive potential to osteoconductive scaffolds such as DBM/allograft. To date, no studies have examined the role of age on fusion outcomes when BMA is utilized despite the well-established deleterious effects of advanced age on bone marrow and MSC potential.
Fifty-one patients that underwent PLF were divided into 3 groups. Group A (n=14) composed of patients age 65 years and older who received BMA with DBM. Group B (n=17) consisted of patients younger than 65 years of age who received BMA with DBM. Group C (n=20) composed of patients age 65 years and older who received ICBG. Fusion rates and clinical outcomes were assessed.
Fusion was significantly lower in group A (35.7%) compared with both groups B (76.4%) and C (80%) (A vs. B, P=0.03; A vs. C, P=0.01). There were no differences in clinical outcomes among all groups except for pseudarthrosis which occurred in 28.6% of patients in group A compared with none and 5% of patients in groups B and C, respectively (A vs. B, P=0.03; A vs. C, P=0.13).
Elderly patients undergoing PLF using DBM enriched with BMA achieved lower radiographic fusion success compared with their nonelderly counterparts and compared with elderly patients that had fusion with ICBG. This may be partly due to the effect of advanced age on MSC potential.
回顾性研究。
评估年龄对富含浓缩骨髓抽吸物（BMA）的同种异体骨/脱矿骨基质（DBM）在后外侧腰椎融合术（PLF）中疗效的影响。
基于细胞的疗法，如浓缩BMA，已被开发为髂嵴骨移植（ICBG）的一种潜在替代方法。BMA含有间充质干细胞（MSC）和生长因子，可赋予骨传导支架（如DBM/同种异体骨）成骨和骨诱导潜能。迄今为止，尽管高龄对骨髓和MSC潜能有明确的有害影响，但尚无研究探讨使用BMA时年龄对融合结果的作用。
51例行PLF的患者分为3组。A组（n = 14）由65岁及以上接受BMA联合DBM的患者组成。B组（n = 17）由年龄小于65岁接受BMA联合DBM的患者组成。C组（n = 20）由65岁及以上接受ICBG的患者组成。评估融合率和临床结果。
A组的融合率（35.7%）显著低于B组（76.4%）和C组（80%）（A组与B组比较，P = 0.03；A组与C组比较，P = 0.01）。除假关节外，所有组的临床结果无差异，A组28.6%的患者发生假关节，而B组和C组分别无患者和5%的患者发生假关节（A组与B组比较，P = 0.03；A组与C组比较，P = 0.13）。
与非老年患者以及接受ICBG融合的老年患者相比，接受富含BMA的DBM进行PLF的老年患者在影像学上融合成功的比例较低。这可能部分归因于高龄对MSC潜能的影响。
