Pinter Zachariah W, Elder Benjamin D, Kaye I David, Kepler Christopher K, Wagner Scott, Freedman Brett A, Sebastian Arjun S
Departments of Orthopedic Surgery.
Neurologic Surgery, Mayo Clinic, Rochester, MN.
Clin Spine Surg. 2022 Feb 1;35(1):E77-E86. doi: 10.1097/BSD.0000000000001262.
This was a narrative review.
This review discusses our current knowledge regarding cellular-based allografts while highlighting the key gaps in the literature that must be addressed before their widespread adoption.
Iliac crest bone graft is the gold-standard bone graft material but is associated with donor site morbidity. Commonly utilized bone graft extenders such as demineralized bone matrix and bone morphogenetic protein have conflicting data supporting their efficacy and lack the osteogenic potential of new cellular-based allograft options.
An extensive literature review was performed. The literature was then summarized in accordance with the authors' clinical experience.
There is not widespread evidence thus far that the addition of the osteogenic cellular component to allograft enhances spinal fusion, as a recent study by Bhamb and colleagues demonstrated superior bone formation during spine fusion in an aythmic rat model when demineralized bone matrix was used in comparison to Osteocel Plus. Furthermore, the postimplantation cellular viability and osteogenic and osteoinductive capacity of cellular-based allografts need to be definitively established, especially given that a recent study by Lina and colleagues demonstrated a paucity of bone marrow cell survival in an immunocompetent mouse posterolateral spinal fusion model.
This data indicates that the substantially increased cost of these cellular allografts may not be justified.
Level V.
这是一篇叙述性综述。
本综述讨论了我们目前关于基于细胞的同种异体移植物的知识，同时强调了在其广泛应用之前必须解决的文献中的关键空白。
髂嵴骨移植是骨移植材料的金标准，但与供区并发症相关。常用的骨移植增强剂，如脱矿骨基质和骨形态发生蛋白，支持其疗效的数据相互矛盾，并且缺乏新的基于细胞的同种异体移植选项的成骨潜力。
进行了广泛的文献综述。然后根据作者的临床经验对文献进行了总结。
到目前为止，尚无广泛证据表明在同种异体移植物中添加成骨细胞成分可增强脊柱融合，正如Bhamb及其同事最近的一项研究表明，与Osteocel Plus相比，在无节律大鼠模型的脊柱融合过程中，使用脱矿骨基质时骨形成更佳。此外，基于细胞的同种异体移植物植入后的细胞活力以及成骨和骨诱导能力需要明确确定，特别是考虑到Lina及其同事最近的一项研究表明，在具有免疫活性的小鼠后外侧脊柱融合模型中骨髓细胞存活率较低。
这些数据表明，这些基于细胞的同种异体移植物大幅增加的成本可能不合理。
V级。
