Chotivichit Areesak, Ruangchainikom Monchai, Tongdee Trongtum, Wongkajornsilp Adisak, Permpikul Parichart, Korwutthikulrangsri Ekkapoj
J Med Assoc Thai. 2016 Oct;99(10):1073-9.
Bone marrow (BM), which is a good source of stem cells and biological factors, has the potential to enhance bone fusion. Simple centrifugation technique is one of the procedures used to concentrate BM aspirate for increasing number of cells. However, there are limited clinical study for using BM concentrate augmentation in spinal fusion.
This study was designed to examine the spinal fusion enhancement effects of bone marrow (BM) concentrate augmentation on poster lateral lumbar fusion (PLF) with autologous local bone graft in terms of both quality and quantity, as compared with a control procedure without BM concentrate augmentation.
Twelve patients with L4-L5 spondylolisthesis scheduled for PLF after decompressive laminectomy and pedicle screw instrumentation were included in this study. This prospective randomized controlled trial was conducted at Siriraj Hospital during the 2009 to 2012 study period. Patients were randomly assigned to two groups. One group underwent PLF with local bone graft with BM concentrate augmentation (BM group) and the other group underwent PLF with local bone graft only (non-BM group). Clinical outcomes were evaluated by the Oswestry Disability Index (ODI) preoperatively and at 3 and 6 months after PLF. Bone fusion quality was evaluated by bony bridging on 3D-CT imaging. Fusion mass volumes were measured on quantitative 3D-CT scans at 1 week and 6 months, postoperatively.
Clinical outcome scores did not differ between groups. Six-month postoperative 3D-CT imaging showed complete PLF bridging in 58.3% and 100% of patients in the BM and non-BM groups, respectively. PLF mass volumes were decreased at 6 months by 51.1% in the BM group and by 48.5% in the non-BM group. One patient in the BM group had local inflammation at the BM aspiration site.
Bone marrow concentrate augmentation in this small randomized controlled trial failed to demonstrate positive effects on autologous local bone graft in posterolateral lumbar fusion relative to both quality and quantity. The high percentage of incomplete bridging should also be noted and further investigated.
骨髓是干细胞和生物因子的良好来源，具有增强骨融合的潜力。简单离心技术是用于浓缩骨髓抽吸物以增加细胞数量的方法之一。然而，关于在脊柱融合中使用浓缩骨髓增强的临床研究有限。
本研究旨在从质量和数量两方面，与未使用浓缩骨髓增强的对照手术相比，检验浓缩骨髓增强对自体局部骨移植的后外侧腰椎融合（PLF）的脊柱融合增强效果。
本研究纳入了12例计划在减压椎板切除和椎弓根螺钉内固定术后行PLF的L4-L5椎体滑脱患者。这项前瞻性随机对照试验于2009年至2012年研究期间在诗里拉吉医院进行。患者被随机分为两组。一组接受自体局部骨移植并添加浓缩骨髓的PLF（骨髓组），另一组仅接受自体局部骨移植的PLF（非骨髓组）。术前以及PLF术后3个月和6个月通过Oswestry功能障碍指数（ODI）评估临床结果。通过三维CT成像上的骨桥接评估骨融合质量。术后1周和6个月通过定量三维CT扫描测量融合块体积。
两组之间的临床结果评分没有差异。术后6个月的三维CT成像显示，骨髓组和非骨髓组分别有58.3%和100%的患者实现了完全的PLF骨桥接。骨髓组融合块体积在6个月时减少了51.1%，非骨髓组减少了48.5%。骨髓组有1例患者在骨髓抽吸部位出现局部炎症。
在这项小型随机对照试验中，相对于质量和数量而言，浓缩骨髓增强未能显示出对后外侧腰椎融合中自体局部骨移植的积极作用。还应注意并进一步研究不完全骨桥接的高比例情况。
